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Injury and treatment patterns of ballistic pelvic fractures by anatomic location

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Introduction

Pelvic ballistic injuries threaten critical gastrointestinal, vascular, and urinary structures. We report the treatment patterns and injury profiles of ballistic pelvic fractures and the association between location of ballistic fractures of the pelvis and visceral injuries.

Methods

A prospectively collected database at an academic level I trauma center was reviewed for clinical and radiographic data on patients who sustained one or more ballistic fractures of the pelvis. Main outcomes compared included: procedures with orthopedic surgery, emergent surgery, concomitant intrapelvic injuries, and mortality.

Results

Eighty-six patients were included. Eight patients (9.3%) underwent surgical debridement with orthopedic surgery, no ballistic pelvic fractures required surgical stabilization. The anatomical locations of ballistic pelvic fractures included: 10 (14.7%) anterior ring, 13 (19.1%) posterior ring, 27 (39.7%) anterior column, and 18 (20.9%) posterior column. There was a statistically significant association between anterior ring and rectal injury. The association between anterior ring injury and bladder injury approached significance.

Conclusions

This case series included 86 patients with a ballistic fracture of the pelvis, none requiring pelvic ring surgical stabilization. The unpatterned behavior of these injuries demands a high suspicion for visceral injury, with special attention to the rectum and bladder in the setting of anterior ring involvement.

Level of Evidence

IV.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Mary Kate Erdman, Meghan Brown, Douglass Tucker, Mark E. Fleming & Geoffrey S. Marecek

  2. Yale Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA

    Alana M. Munger & Kenji Inaba

  3. Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA

    Morgan Schellenberg

Authors
  1. Mary Kate Erdman
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  2. Alana M. Munger
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  3. Meghan Brown
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  4. Morgan Schellenberg
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  5. Douglass Tucker
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  6. Kenji Inaba
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  7. Mark E. Fleming
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  8. Geoffrey S. Marecek
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Corresponding author

Correspondence to Mary Kate Erdman.

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Conflict of interest

G. S. Marecek receives research support from BoneSupport AB, consulting fees from Globus Medical, DePuy Synthes, NuVasive, and Zimmer Biomet, and he is a committee or board member for the Orthopaedic Trauma Association and Western Orthopaedic Association. The remaining authors have nothing to disclose.

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Erdman, M.K., Munger, A.M., Brown, M. et al. Injury and treatment patterns of ballistic pelvic fractures by anatomic location. Eur J Orthop Surg Traumatol 31, 111–119 (2021). https://doi.org/10.1007/s00590-020-02744-w

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  • DOI: https://doi.org/10.1007/s00590-020-02744-w

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