[Pelvic fractures: early management of hemodinamically unstable patients].

INTRODUCTION: Fractures that compromise pelvic and/or acetabular mechanical stability are usually injuries caused by high energy mechanisms and are life threatening.

OBJECTIVE: To present the treatment options for the early stabilization of pelvic rim injuries and acetabular fractures in hemodinamically unstable patients.

MATERIAL AND METHODS: Retrospective, cross-sectional, descriptive study in patients with diagnosis of pelvic ring or acetabular fracture and hemodynamic instability seen in the emergency room between January 2002 and December 2010. The mechanisms of injury were identified and the following variables were considered: sex, age, type of fracture, time course, associated injuries, early and definitive management.

RESULTS: Fifteen patients were included; 9 with pelvic fracture, and 6 with acetabular fracture or both, who had hemodynamic instability resulting from hypovolemia: 8 males (53.3%) and 7 females (46.6%) with an age range of 18-72 years. The most common mechanism of injury was motor vehicle accident in 8 cases (53.3%), motorcycle accident in 2 (13.3%), fall in 2 (133%), and being run over in 3 patients (20%). All of them had associated injuries. Initial management consisted of external fixation with a standard fixator in 6 cases; C clamp in one case; girdle-like pelvic bandage in 2; laparotomy with packing and definitive primary osteosynthesis in one case. Results were assessed after a minimum of 3 years and were classified into excellent, 10 (76.9%) good, 1 (7.7%) fair, 0 and poor 1 (7.7%). One female patient (7.7%) died 8 hours after admission.

CONCLUSION: Unstable pelvic or acetabular fractures are injuries produced mostly by high energy mechanisms and are life threatening in most cases. Initial management is extremely important for treatment course and final outcome. In cases that present initially with hemodynamic instability mortality is higher and management should be much more aggressive.