Acetabular and isolated pelvic ring fractures: A comparison of initial assessment and outcome

Abstract

The purpose of this study was to describe the comparative outcomes of patients with pelvic ring fractures, acetabular fractures, and combinations of the same. Patients with pelvic or acetabular fractures were identified in the Hospital Trauma Registry, and all appropriate data were collected by reviewing the patients' medical records, the hospital operative logs, transfusion records, and the records of surgical morbidity conferences. Patient management was consistent over the time period of the study. Univariate analysis of continuous variables was done using Student's t test; and categorical variables were analyzed with χ2 analysis. All statistical analysis was performed using JMP software (SAS International Inc., Cary, NC) with significance set at P < 0.05. One thousand, three hundred and thirty-four patients with 320 acetabular, 826 pelvic ring, and 188 combination fractures over 10 years were analyzed. Age, race, and gender were typical of trauma patients and similar amongst groups. Injury Severity Score was significantly higher (21.3 vs 12.9, P < 0.05) and Glasgow Coma Scale was significantly lower (12.5 vs 13.6, P < 0.05) in patients with pelvic ring fractures as compared with acetabular fractures. Hypotension was more common in patients with pelvic ring fractures (13.9% vs 5.3%, P < 0.05). Patients with pelvic ring fractures required more blood transfusions (3.83 vs 1.36, P < 0.05) and base deficit was lower (-6.7 vs -5.5, P = 0.03). Mortality was significantly higher among patients with pelvic ring fractures (16.5% vs 5.6%, P < 0.01). Among survivors, hospital length of stay (LOS) (18.7 vs 14.8 days, P = 0.08) and intensive care unit LOS (7.8 vs 4.7 days, P = 0.008) were significantly longer with pelvic ring fractures. Functional Independence Measurement scores trended to a higher functional outcome in patients with acetabular fractures (10.3 vs 10.0, P = 0.08). Patients with pelvic ring fractures have a worse admission base deficit, higher transfusion requirements, and increased hypotension on admission. This is reflected in their significantly higher mortality and longer hospital and intensive care unit LOS in survivors. Such clinical information is helpful when caring for patients with acetabular vs pelvic ring fractures.