THE ACUTE MANAGEMENT OF HEMODYNAMICALLY UNSTABLE MULTIPLE TRAUMA PATIENTS WITH PELVIC RING FRACTURES

The management of hemodynamically unstable patients with displaced pel vic ring fractures and associated abdominal, thoracic, or head injurie s is controversial. We studied 312 consecutive trauma patients with pe lvic fractures admitted from July 1, 1989 through June 30, 1993: thirt y-six of these patients were in shock (SBP less-than-or-equal-to 90 mm Hg) and were treated by a protocol including volume resuscitation, an d treatment of the associated injuries, without use of acute external fixation. Evaluation of the pelvic fractures revealed 39% to be rotati onally unstable; 61% were both rotationally and vertically unstable. T he mean Injury Severity Score was 27 +/- 12, the average Glasgow Coma Scale score was 12 +/- 5, and the Abbreviated Injury Scale (AIS) score s stratified for the abdomen and the thorax were 1.9 +/- 1.7 and 1.6 /- 1.8, respectively. Eighteen patients required thoracotomy, laparoto my, or both. The total blood requirement in the initial 24 hours posti njury was 4.0 +/- 4 Units. Deaths of four patients (11%) were a functi on of associated injuries and comorbid factors, not the result of unco ntrolled pelvic hemorrhage. The data suggest that aggressive resuscita tion of these patients and treatment of extrapelvic injuries in conjun ction with early or delayed ORIF, without application of acute externa l fixation, resulted in a low overall mortality rate.