SELECTIVE FECAL DIVERSION IN COMPLEX OPEN PELVIC FRACTURES FROM BLUNTTRAUMA

Objective: To review the outcomes of patients with open pelvic fractur es. Design: Retrospective review of medical records. Setting: Patients admitted from the injury scene or transferred within 24 hours to a le vel I trauma center. Patients: Thirty-three patients sustaining blunt trauma had pelvic fractures and adjacent wounding. Interventions: Trea tment protocol that included selective fecal diversion, measures to ar rest hemorrhage and prevent wound sepsis, manage associated pelvic inj uries, and provide optimal orthopedic outcomes. Main Outcome Measures: Death and sepsis. Results: Exsanguination occurred in one patient and death owing to head injuries occurred in five patients. Wound sepsis occurred in 31% of patients with colostomy and 19% without colostomy. Conclusions: Management of open pelvic fractures requires a well-coord inated group using several techniques. Selected patients with open pel vic fractures do not require fecal diversion. Incisions for orthopedic surgery should be considered when decisions are made regarding fecal diversion.