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.