Management of Severe Perineal Injuries in Major Pelvic Fractures

Significant perineal injuries and major pelvic fractures resulting from blunt trauma manifest a high-energy injury. Open pelvic fractures (with perineal injury) are associated with higher mortality rates of 40 to 60 %. This study was a review of patients with multiple traumas comprising of major pelvic fracture and severe perineal injuries (Shahid Kamyab hospital in Mashhad from 2002- 2005). A total of 11 patients, with pelvic fracture and perineal injuries (injury to urethra and anal canal) were entered in the study. The data was gathered by a checklist and analyzed with SPSS software. The population under study included 11 patients (9 male, 2 female) with a mean age of 35years. Cause of trauma in all patients was motor vehicle accidents. All of the patients in the first 6 hours of admission received at least 4 liters of serum ringer lactate and 3 units of packed cells. The mean of packed cell received was 8 units and one patient needed 21 units of packed cells. All of patients were taken to the operating room for diverting colostomy, distal rectal washout, cystostomy and radical debridment and irrigation of devitalized tissue. Good results were achieved in 9 patients and there was one case of mortality and one morbidity (ARF). Open pelvic fractures and perineal injuries are associated with higher mortality rates. Prompt diagnosis and proper treatment (reanimation, colostomy, cystostomy, debridment and irrigation) is the key to success.