Pedestrian pelvic fractures: 5-year experience of a major urban trauma center

Background: Pedestrian injury accounts for approximately 14% of all vehicular-associated mortality. We performed a retrospective review of 1,014 injured pedestrians admitted to our statewide trauma center between January 1, 1990, and December 31, 1994, to determine the pattern and severity of pelvic injury in injured pedestrians, the types of associated injuries relative to those pelvic injury patterns, and the relationship between pelvic fracture treatment modalities and patient outcome. Methods: Approximately 11% (111 of 1,014) of the patients had high-energy pelvic ring disruptions. The average age of these 57 men and 54 women was 39.4 years. The average admission Injury Severity Score and Glasgow Coma Scale values were 29.2 and 11.7, respectively. Pelvic injuries were classified according to the mechanism of injury: lateral compression, anteroposterior compression, vertical shear, and combined mechanical injury fractures. We compared the mean Glasgow Coma Scale scores, blood utilization, number of associated injuries, and mortality rate for each classification. Results: Associated trauma included neurologic (30 of 111, 27.0%), thoracic (29 of 111, 26.1%), and abdominal injury (16 of 111, 14.4%). Overall blood product utilization averaged 1,971 mt within the first 24 hours and overall mortality was 26 of 111 (23.4%). There were 79 (71.2%) lateral compression, 23 (20.7%) anteroposterior compression, six (5.4%) vertical shear, and three (2.7%) combined mechanical injury fractures. As the severity of lateral compression and anteroposterior compression pelvic fractures increased, Glasgow Coma Scale scores decreased and Injury Severity Score values, blood utilization, number of associated injuries, and mortality rate increased. The highest mortality rate (50%) was associated with the most severe (grade III) lateral compression and anteroposterior compression injuries. Of particular interest, was the difference in the 24-hour blood utilization and mortality rates for patients with lateral compression type II pelvic fractures treated before (nonoperative management) and after (early external fixation) 1993: 4,760 versus 1,375 mL of blood and 36.4 versus 12.5% mortality rate, respectively. Conclusions: In conclusion, pelvic fracture appears to be a substantial factor in pedestrian morbidity and mortality. Although most pedestrian morbidity and mortality is not caused by the intrinsic nature of the pelvic fracture, the severity of these injuries is correlated with the degree of destructive energy imparted to the body as a whole, as manifested by the number and severity of associated injuries and the mortality rate.