Selective fecal diversion in complex open pelvic fractures from blunt trauma

Abstract

Objective: To review the outcomes of patients with open pelvic fractures.

Design: Retrospective review of medical records.

Setting: Patients admitted from the injury scene or transferred within 24 hours to a level 1 trauma center.

Patients: Thirty-three patients sustaining blunt trauma had pelvic fractures and adjacent wounding.

Interventions: Treatment protocol that included selective fecal diversion, measures to arrest hemorrhage and prevent wound sepsis, manage associated pelvic injuries, and provide optimal orthopedic outcomes.

Main outcome measures: Death and sepsis.

Results: Exsanguination occurred in one patient and death owing to head injuries occurred in five patients. Wound sepsis occurred in 31% of patients with colostomy and 19% without colostomy.

Conclusions: Management of open pelvic fractures requires a well-coordinated group using several techniques. Selected patients with open pelvic fractures do not require fecal diversion. Incisions for orthopedic surgery should be considered when decisions are made regarding fecal diversion.