Pelvic fractures and thoracolumbar spine injury: A critical overlook in high-impact vehicular trauma management

Abstract

Introduction

Pelvic fractures (PF) occur in up to 9 % of trauma cases, primarily from high-impact events, and are associated with increased morbidity and mortality due to frequent concomitant injuries. Thoracolumbar (TL) spinal fractures, particularly at the T10-L2 junction, are also common in high-energy trauma but are less frequently examined in association with PF. Missed TL fractures can lead to serious neurological deficits. Although Advanced Trauma Life Support (ATLS) recommends screening for TL fractures in trauma patients, no standardized guidelines exist. This study aims to explore the relationship between PF and TL fractures in trauma patients and to identify key variables associated with these injuries.

Methods

This retrospective cohort study analyzed data from the 2021 National Trauma Data Bank (NTDB), focusing on patients with PF resulting from high-impact blunt trauma. Patients were identified using ICD-9 codes for pelvic fractures, and those under 18 years of age or with penetrating trauma were excluded. We collected demographic data, injury grading (Injury Severity Score [ISS], Abbreviated Injury Scale [AIS]), and patient outcomes, comparing those with isolated pelvic fractures (IPF) to those with concomitant pelvic and TL fractures (PTLF).

Results

Of the 37,987 patients with PF, 32.4 % (n = 12,318) had concomitant TL fractures. PTLF patients were older (mean age 44.12 vs. 40.12 years, p < 0.001) and exhibited higher ISS and AIS scores compared to IPF patients. The PTLF group had longer hospital stays (14.51 days vs. 9.4 days, p < 0.001) and higher rates of ICU admission (41.4 % vs. 24.0 %, p < 0.001) and mortality (9.5 % vs. 4.3 %, p < 0.001). PTLF patients were less likely to be discharged home (29.5 % vs. 43.5 %, p < 0.001) and more likely to be transferred to rehabilitation or long-term care facilities. Motor vehicle collisions were the most common mechanism of injury, but auto-pedestrian accidents were more frequent in the PTLF group (17.3 % vs. 11.1 %, p < 0.001). Lumbar spine fractures accounted for 70.2 % of TL injuries.

Conclusion

Pelvic fractures from high-impact trauma are strongly associated with concomitant TL fractures, which lead to worse clinical outcomes. Routine TL spine screening in these patients is recommended to ensure timely diagnosis and treatment