A Retrospective Study of Ballistic Pelvic Fractures with Focus on Short-Term Clinical Outcomes.

Abstract

Objectives: To evaluate the orthopaedic management, associated injuries, and outcomes in patients treated for low-velocity ballistic pelvic fractures.

Methods: Design: Retrospective chart review.

Setting: Single urban Level I Trauma Center.

Patient selection criteria: Patients aged 15 years or older treated for low-velocity ballistic pelvic (OTA/AO 61 and 62) fractures from May 2018 to August 2021.

Outcome measures and comparisons: Primary study measures included pelvic fracture location, concomitant associated injuries, surgical interventions, and antibiotic treatment. Post-injury sequelae evaluated include infection, neurologic deficit, and need for orthopaedic removal of foreign body. Risk factors for post-injury sequelae were investigated.

Results: A total of 156 patients with ballistic pelvic fractures were included. The cohort consisted of 135 (86.5%) males and a mean age of 29.8 years. One hundred and ten (70.5%) patients sustained two or more GSWs. Ninety-eight (62.8%) patients underwent an exploratory laparotomy with 79 (50.6%) having a confirmed concomitant intestinal injury. Additional associated injuries included nerve injury (13.5%), vascular injury requiring repair or embolization (10.9%), and bladder injury (10.3%). Nine (5.7%) patients underwent orthopaedic operative management - five (3.2%) patients for operative fixation and four (2.5%) patients for removal intra-articular foreign bodies. Diabetes (OR: 33.1, p=0.025), neurologic deficit on presentation (OR: 525.2, p<0.001), vascular injury requiring repair or embolization (OR 8.7, p=0.033), and orthopaedic pelvic fixation (OR: 163.5, p=0.004) were positively associated with the defined post-injury sequelae at 30 and 90 days of follow-up. There was not a statistically significant association between infection and retained foreign body (OR: 3.95 [95% CI 0.3 - 58.7, p = 0.318]) or bowel contamination (OR: 6.91 [95% CI 0.4 - 58.7, p = 0.178]).

Conclusions: Ballistic fractures of the pelvis and acetabulum rarely underwent operative fixation (3.2%) or irrigation and debridement. Neither retained foreign body nor presumed bowel contamination of pelvic fractures had a statistically significant association with infection which further supports conservative management of these injuries. Patients with diabetes, neurologic deficit on presentation, vascular injury necessitating intervention, and orthopaedic fixation of pelvic fracture are associated with increased risk of post-injury sequelae.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.