Impact of pelvic fractures on the early clinical outcomes of severely injured trauma patients

  • K. Almahmoud
  • R. Pfeifer
  • K. Al-Kofahi
  • A. Hmedat
  • W. Hyderabad
  • F. Hildebrand
  • A. B. Peitzman
  • H.-C. Pape
Original Article



Pelvic fractures contribute to morbidity and mortality following injury. We sought to study the impact of pelvic fractures on the clinical course and outcomes of trauma patients with a pelvic fracture in comparison to patients with similar injury severity without pelvic fracture to identify potential parameters to track patients’ clinical course post-injury.


A cohort of 206 consecutive blunt trauma survivors, studied over a 5-year period in a level I trauma center of which 75 patients (36.4%) had a pelvic fracture, was included in the study. To perform a retrospective cohort study with matched controls, 60 patients of the pelvic fracture group [(PF), 41 males and 19 females; age: 40 ± 17; injury severity score (ISS): 26.6 ± 9.3] were compared to 60 patients without pelvic fracture (non-PF) trauma as controls (41 males and 19 females; age: 40 ± 13; ISS: 26.9 ± 7.7), both with matching age (±5 years), sex, and ISS (±5 points).


Statistically significant differences were observed in Intensive Care Unit (ICU) length of stay (LOS), total LOS, and Marshall MOD score between PF and non-PF groups, respectively. Acid–base markers such as pH, lactate, LDH, and base deficit were all significantly altered in PF compared to non-PF cohort upon admission. Moreover, our analysis showed significant differences in inflammatory biomarkers (Prolactin, CRP, and IL-6), and clinical parameters (CPK, Hgb, Platelets count, and WBC) over the 7-day clinical course in patients with PF when compared to non-PF cohort.


In this matched cohort, patients with pelvic fractures exhibited biochemical and physiological alterations upon admission. Furthermore, our results suggest that pelvic fracture affects the clinical outcomes in severely injured patients, independently of injury severity, mechanism of injury, age or gender.


Trauma Injury Pelvic fracture Damage control Clinical outcomes Clinical parameters 



Abbreviated injury scale


Injury severity score


Intensive care unit


Length of stay


Multiple organ dysfunction syndrome


Advanced trauma life support


Base deficit


Lactate dehydrogenase


Creatine phosphokinase


C-reactive protein




Compliance with ethical standards

This study was approved by the University of Aachen Medical Center Institutional Review Board. The work was performed in accordance with internationally accepted ethical standards.

Conflict of interest

All authors declare that they have no conflict of interest.


  1. 1.
    Pejcic T, Loncar Z, Rafailovic D, Acimovic M, Dzamic Z, Hadzi-Djokic J. Genitourinary injuries associated with pelvic fractures. Acta Chir Iugosl. 2013;60(2):117–20.CrossRefPubMedGoogle Scholar
  2. 2.
    Nicola R. Early total care versus damage control: current concepts in the orthopedic care of polytrauma patients. ISRN Orthop. 2013;2013:329452. doi: 10.1155/2013/329452.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Giannoudis PV, Grotz MR, Tzioupis C, Dinopoulos H, Wells GE, Bouamra O, et al. Prevalence of pelvic fractures, associated injuries, and mortality: the United Kingdom perspective. J Trauma. 2007;63(4):875–83. doi: 10.1097/01.ta.0000242259.67486.15.CrossRefPubMedGoogle Scholar
  4. 4.
    Bircher M. Pelvic and acetabular fractures past, present, and future. AODialogue. 2007;01/07:36–39Google Scholar
  5. 5.
    Mors K, Braun O, Wagner N, Auner B, Voth M, Stormann P, et al. Influence of gender on systemic IL-6 levels, complication rates and outcome after major trauma. Immunobiology. 2016. doi: 10.1016/j.imbio.2016.03.005.Google Scholar
  6. 6.
    Schonenberger A, Billeter AT, Seifert B, Neuhaus V, Trentz O, Turina M. Opportunities for improved trauma care of the elderly - a single center analysis of 2090 severely injured patients. Arch Gerontol Geriatr. 2012;55(3):660–6. doi: 10.1016/j.archger.2012.02.013.CrossRefPubMedGoogle Scholar
  7. 7.
    Fulkerson EW, Egol KA. Timing issues in fracture management: a review of current concepts. Bull NYU Hosp Jt Dis. 2009;67(1):58–67.PubMedGoogle Scholar
  8. 8.
    Flint L, Cryer HG. Pelvic fracture: the last 50 years. J Trauma. 2010;69(3):483–8. doi: 10.1097/TA.0b013e3181ef9ce1.CrossRefPubMedGoogle Scholar
  9. 9.
    Martin S, Casey N. Haemorrhage requiring embolisation after low energy pelvic fracture in an elderly patient: a case report. Emerg Med J. 2010;27(9):722–3. doi: 10.1136/emj.2009.084475.CrossRefPubMedGoogle Scholar
  10. 10.
    Fox MA, Mangiante EC, Fabian TC, Voeller GR, Kudsk KA. Pelvic fractures: an analysis of factors affecting prehospital triage and patient outcome. South Med J. 1990;83(7):785–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Almahmoud K, Namas RA, Zaaqoq AM, Abdul-Malak O, Namas R, Zamora R, et al. Prehospital hypotension is associated with altered inflammation dynamics and worse outcomes following blunt trauma in humans. Crit Care Med. 2015;43(7):1395–404. doi: 10.1097/CCM.0000000000000964.CrossRefPubMedGoogle Scholar
  12. 12.
    Almahmoud K, Namas RA, Abdul-Malak O, Zaaqoq AM, Zamora R, Zuckerbraun BS, et al. Impact of injury severity on dynamic inflammation networks following blunt trauma. Shock. 2015;44(2):101–9. doi: 10.1097/SHK.0000000000000395.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Almahmoud K, Teuben M, Andruszkow H, Horst K, Lefering R, Hildebrand F, et al. Trends in intubation rates and durations in ventilated severely injured trauma patients: an analysis from the TraumaRegister DGU®. Patient Saf Surg. 2016;10(1):24. doi: 10.1186/s13037-016-0109-6.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.CrossRefPubMedGoogle Scholar
  15. 15.
    Gennarelli TA, Wodzin E. AIS 2005: a contemporary injury scale. Injury. 2006;37(12):1083–91. doi: 10.1016/j.injury.2006.07.009.CrossRefPubMedGoogle Scholar
  16. 16.
    Audige L, Bhandari M, Kellam J. How reliable are reliability studies of fracture classifications? A systematic review of their methodologies. Acta Orthop Scand. 2004;75(2):184–94. doi: 10.1080/00016470412331294445.CrossRefPubMedGoogle Scholar
  17. 17.
    Zenati MS, Billiar TR, Townsend RN, Peitzman AB, Harbrecht BG. A brief episode of hypotension increases mortality in critically ill trauma patients. JTrauma. 2002;53(2):232–6.Google Scholar
  18. 18.
    Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23(10):1638–52.CrossRefPubMedGoogle Scholar
  19. 19.
    Sauaia A, Moore EE, Johnson JL, Ciesla DJ, Biffl WL, Banerjee A. Validation of postinjury multiple organ failure scores. Shock. 2009;31(5):438–47. doi: 10.1097/SHK.0b013e31818ba4c6.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Sperry JL, Friese RS, Frankel HL, West MA, Cuschieri J, Moore EE et al. Male gender is associated with excessive IL-6 expression following severe injury. The Journal of trauma. 2008;64(3):572–8. doi: 10.1097/TA.0b013e3181650fdf (discussion 8–9).CrossRefPubMedGoogle Scholar
  21. 21.
    Jastrow KM, Gonzalez EA, McGuire MF, Suliburk JW, Kozar RA, Iyengar S, et al. Early cytokine production risk stratifies trauma patients for multiple organ failure. J Am Coll Surg. 2009;209(3):320–31. doi: 10.1016/j.jamcollsurg.2009.05.002.CrossRefPubMedGoogle Scholar
  22. 22.
    Gustavo Parreira J, Coimbra R, Rasslan S, Oliveira A, Fregoneze M, Mercadante M. The role of associated injuries on outcome of blunt trauma patients sustaining pelvic fractures. Injury. 2000;31(9):677–82.CrossRefPubMedGoogle Scholar
  23. 23.
    Cordts Filho Rde M, Parreira JG, Perlingeiro JA, Solda SC, Campos T, Assef JC. Pelvic fractures as a marker of injury severity in trauma patients. Rev Col Bras Cir. 2011;38(5):310–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Berg RJ, Okoye O, Teixeira PG, Inaba K, Demetriades D. The double jeopardy of blunt thoracoabdominal trauma. ArchSurg. 2012;147(6):498–504. p[doi].Google Scholar
  25. 25.
    DeLong WG, Jr., Born CT. Cytokines in patients with polytrauma. Clin Orthop Relat Res. 2004(422):57–65.Google Scholar
  26. 26.
    Lenz A, Franklin GA, Cheadle WG. Systemic inflammation after trauma. Injury. 2007;38(12):1336–45. doi: 10.1016/j.injury.2007.10.003.CrossRefPubMedGoogle Scholar
  27. 27.
    Sperry JL, Friese RS, Frankel HL, West MA, Cuschieri J, Moore EE, et al. Male gender is associated with excessive IL-6 expression following severe injury. JTrauma. 2008;64(3):572–8. doi: 10.1097/TA.0b013e3181650fdf.Google Scholar
  28. 28.
    Maier B, Lefering R, Lehnert M, Laurer HL, Steudel WI, Neugebauer EA, et al. Early versus late onset of multiple organ failure is associated with differing patterns of plasma cytokine biomarker expression and outcome after severe trauma. Shock. 2007;28(6):668–74.PubMedGoogle Scholar
  29. 29.
    Rice PL Jr, Rudolph M. Pelvic fractures. Emerg Med Clin North Am. 2007;25(3):795–802. doi: 10.1016/j.emc.2007.06.011.Google Scholar
  30. 30.
    Hou Z, Smith WR, Strohecker KA, Bowen TR, Irgit K, Baro SM, et al. Hemodynamically unstable pelvic fracture management by advanced trauma life support guidelines results in high mortality. Orthopedics. 2012;35(3):e319–e24. doi: 10.3928/01477447-20120222-29.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Orthopaedic Trauma SurgeryUniversity of Aachen Medical CentreAachenGermany
  2. 2.Department of Surgery, Division of Trauma and Critical Care SurgeryUniversity of PittsburghPittsburghUSA
  3. 3.Department of Molecular BioscienceUniversity of KansasKansasUSA
  4. 4.Department of General SurgeryMethodist Dallas Health SystemDallasUSA

Personalised recommendations