Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL; and.
Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA.
J Orthop Trauma. 2024 Nov 1;38(11):602-608. doi: 10.1097/BOT.0000000000002876.
To evaluate the orthopaedic management, associated injuries, and outcomes in patients treated for low-velocity ballistic pelvic fractures.
Retrospective chart review.
Single, urban, Level I trauma center.
Patients 15 years or older treated for low-velocity ballistic pelvic (OTA/AO 61 and 62) fractures from May 2018 to August 2021.
Primary study measures included pelvic fracture location, concomitant associated injuries, surgical interventions, and antibiotic treatment. Postinjury sequelae evaluated include infection, neurologic deficit, and need for orthopaedic removal of foreign body. Risk factors of postinjury sequelae were investigated.
A total of 156 patients with ballistic pelvic fractures were included. The cohort consisted of 135 (86.5%) male patients with a mean age of 29.8 years. One hundred ten (70.5%) patients sustained 2 or more gunshot wounds. Ninety-eight (62.8%) patients underwent an exploratory laparotomy with 79 (50.6%) having a confirmed concomitant intestinal injury. Additional associated injuries included nerve injury (13.5%), vascular injury requiring repair or embolization (10.9%), and bladder injury (10.3%). Nine (5.7%) patients underwent orthopaedic operative management-five (3.2%) patients for operative fixation and 4 (2.5%) patients for removal of intra-articular foreign bodies. Diabetes (odds ratio [OR]: 33.1, P = 0.025), neurologic deficit on presentation (OR: 525.2, P < 0.001), vascular injury requiring repair or embolization (OR: 8.7, P = 0.033), and orthopaedic pelvic fixation (OR: 163.5, P = 0.004) were positively associated with the defined postinjury sequelae at 30 and 90 days of follow-up. There was not a statistically significant association between infection and retained foreign body (OR: 3.95 [95% CI 0.3-58.7, P = 0.318]) or bowel contamination (OR: 6.91 [95% CI 0.4-58.7, P = 0.178]).
Ballistic fractures of the pelvis and acetabulum rarely required operative fixation (3.2%) or irrigation and debridement. Neither retained foreign body nor presumed bowel contamination of pelvic fractures had a statistically significant association with infection, which further supports conservative management of these injuries. Patients with diabetes, neurologic deficit on presentation, vascular injury necessitating intervention, and orthopaedic fixation of pelvic fracture are associated with increased risk of postinjury sequelae.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估低能弹道性骨盆骨折患者的骨科处理、合并损伤和结局。
回顾性病历分析。
单中心，城市，1 级创伤中心。
2018 年 5 月至 2021 年 8 月期间接受低能弹道性骨盆（OTA/AO 61 和 62）骨折治疗的 15 岁及以上患者。
包括骨盆骨折部位、合并的相关损伤、手术干预和抗生素治疗。评估的损伤后后遗症包括感染、神经功能缺损和需要骨科取出异物。调查了损伤后后遗症的危险因素。
共纳入 156 例弹道性骨盆骨折患者。该队列由 135 例（86.5%）男性患者组成，平均年龄 29.8 岁。110 例（70.5%）患者有 2 个或更多枪伤。98 例（62.8%）患者行剖腹探查术，其中 79 例（50.6%）证实存在合并性肠损伤。其他相关损伤包括神经损伤（13.5%）、需要修复或栓塞的血管损伤（10.9%）和膀胱损伤（10.3%）。9 例（5.7%）患者接受骨科手术治疗-5 例（3.2%）患者行手术固定，4 例（2.5%）患者行关节内异物取出。糖尿病（比值比[OR]：33.1，P=0.025）、入院时神经功能缺损（OR：525.2，P<0.001）、需要修复或栓塞的血管损伤（OR：8.7，P=0.033）和骨科骨盆固定（OR：163.5，P=0.004）与 30 天和 90 天随访时定义的损伤后后遗症呈正相关。感染与残留异物（OR：3.95[95%CI 0.3-58.7，P=0.318]）或肠污染（OR：6.91[95%CI 0.4-58.7，P=0.178]）之间无统计学显著关联。
骨盆和髋臼的弹道性骨折很少需要手术固定（3.2%）或灌洗清创。残留异物或推测的骨盆骨折肠污染与感染无统计学显著关联，这进一步支持对这些损伤进行保守治疗。糖尿病、入院时神经功能缺损、需要干预的血管损伤和骨盆骨折的骨科固定与损伤后后遗症的风险增加相关。
预后 III 级。有关证据水平的完整描述，请参见作者说明。
