Pattern of Pelvic Fractures, Associated Injuries and Early Complications as Seen in Adults at Kenyatta National Hospital

Abstract

Objective: To determine the incidence, pattern, associated injuries and early complications of pelvic fractures in trauma patients presenting at A & E in KNH. Design: Prospective longitudinal study. Setting: Accident and Emergency department, Orthopedic wards and Orthopedic outpatient clinics at KNH. Patient and methods: The study involved patients aged 18 years and above admitted in the orthopedic wards at KNH through A & E department with pelvic fractures and subsequent follow up in the clinics. They were recruited through convenient sampling as they were seen at Accident and Emergency. The patients were managed according to ATLS protocol, and after stabilization, were followed up in the orthopedic wards for 3 weeks. The ATLS protocol involved securing airway, ensuring normal rhythmic breathing, ensuring adequate blood circulation and assessing for disability. Patient demographics, fracture pattern and associated injuries were recorded after consenting for the study. The patient was then followed up for a period of 3 weeks documenting emerging and evolving complications. This was done on day 1, day 7, day 14 and day 21. Clear documentation of pelvic fracture pattern from the AP, in-let and out-let pelvic views, presence or absence of hemorrhagic shock, and all associated injuries. The data was analyzed using means, medians, and proportions for the baseline characteristics. The pelvic fracture pattern was correlated to the mechanism of injury, patient demographics, presence of early complications using the linear regression model as a statistical analytical tool. Results: This study found that majority of patients with pelvic fractures were male with a mean age of 36 years. The average time before initiation of ATLS was 53 minutes. The main mechanism of injury was motor vehicle accidents. The main Tiles fracture type was type B.

This study also found out that 63 % of the pelvic fractures were associated with other injuries. Head injury followed by genito-urinary injuries were the most common associated injuries. This study also showed low incidences of hemorrhagic shock in patients with pelvic fractures. Conclusion: The Tiles classification as originally intended did not predict mechanism of injury. Associated injuries remained a challenge to management of patients with pelvic fractures. Motor vehicle accidents were still the major cause of pelvic fractures. There were low incidences of hemorrhagic shock in those who arrived at the hospital.