Associated peritoneostomy and pelvic ring fractures: prognostic factors in mortality and morbidity.

Abstract

Background: High-energy polytrauma can be presented as an abdominal injury associated with a pelvic ring fracture. In the case of concomitant pelvic ring fracture peritoneostomy at admission, high morbidity and mortality rates could be expected.

Objectives: The main objective of this study is to assess prognostic factors that could contribute to the outcome of polytrauma patients who presented with pelvic ring fractures and were submitted to a peritoneostomy at admission. As a secondary aim, the functional outcome of the survivors was evaluated.

Materials and methods: A retrospective, cross-sectional, observational study was conducted. Polytrauma patients who were submitted to a peritoneostomy at admission due to high-energy abdominal injury and presented with concomitant pelvic ring fracture were included. Demographics data and prognostic factors related to "death" and infection were assessed. We applied the Majeed score for functional evaluation.

Results: A total of 29 patients were included in the study. The mortality rate was 58.6% (n = 17). Considering only patients older than 45 years, the death rate was 90%. The variables with positive correlation to death were: (1) age > 45 years (p < 0.017) and (2) the absence of internal fixation (p < 0.011). Patients undergoing internal fixation had more infection rates (60%) compared to noninternal fixation group (11%) (p < 0.011). The average Majeed score was 54.7 points.

Conclusion: The predictive factors associated with increased mortality were age greater than 45 years and the absence of internal fixation. Concomitant pelvic ring fracture and peritoneostomy in admission implicate on high mortality and morbidity rates.