Research on relation of mortality and hemodynamics in patients with an acute pelvic ring fracture

Objective: To study the treatment pathway of hemodynamic unstable patients with a pelvic ring fracture and analyze the causes of death in this group. Methods: Retrospectively, all data of hemodynamic unstable patients with a pelvic ring fracture in the period 1 January 2003 till 1 June 2010 were analyzed. For all patients the treatment protocol was assessed and compared with our protocol. Results: The data of 268 patients were analyzed. Among them, 89 cases presented as hemodynamic unstable. A total of 22/89 patients died (25%). Seven patients died because of an isolated circulatory problem, 1 of an isolated neurotrauma. Fourteen patients died because of a combination of vital injuries, in which 11 sustained extensive hemorrhage. Hemorrhage contributed to mortality in 18/22 patients (82%). In 12 of the 22 patients who died, the treatment protocol was not followed. This was significantly higher than in the group survivors (P < 0.01). Conclusions: Mortality in patients with a pelvic fracture is most often caused by hemorrhage or sequelae from hemorrhage. A standardized treatment protocol reduces mortality.