Patterns of pelvic ring fractures seen on computed tomography and associated injuries in trauma patients at mulago hospital

Abstract

ABSTRACT Background: Pelvic ring fractures are devastating injuries that commonly occur with related high mortality and morbidity. Those affected often have multiple other associated and commonly life-threatening injuries which require interdisciplinary management and therefore necessitating prioritization of investigations and interventions. Understanding pelvic ring fracture patterns and associated injuries seen in our setting is therefore paramount in justifying and guiding development of management protocols geared towards improving outcomes among patients in the acute setting. Aim: To describe the patterns of pelvic ring fracture seen on CT scan in trauma patients admitted to Mulago hospital and to describe the associated injuries. Methods: This was a cross-sectional study carried out at Mulago hospital A&E. Trauma patients with PRF having been confirmed on plain radiographs were consecutively recruited into the study and a CT scan of the pelvis was done. Demographic data, PRF patterns and associated injuries were recorded on a standardized questionnaire. The patterns were described using both Tile classification and Young and Burgess Classification systems. Categorical variables were summarized as frequency and percentages. Bivariate and Multivariate analysis was done to determine factors associated with unstable PRF. Results: A total of 72 patients were enrolled into the study. Majority (64%) were male. Most (60%) belonged to the age category 18-35years and 82% of the PRF resulted from RTA. Going by patterns LC1 were commonest (26.4%) according to the Young and Burgess Classification and B2 (22.2%) type fractures according to the Tile classification. About 40% of all the PRF seen were considered completely unstable according to both classifications. Among the associated injuries, 43% of the patients sustained associated limb fractures, 39% blunt abdominal trauma, 36% mild head injury and 24% presented in stage II shock. Patients presenting with shock stage II or III, were passengers, in an older age group and had a pneumothorax had a relative risk of having unstable PRF. Conclusion: A higher proportion of unstable PRF patterns was reported in this study compared to an earlier study done in the same setting using plain radiographs alone suggesting either more diagnosis using CT scan or change in the patterns seen. PRF especially following high energy trauma in our setting are associated with multiple other often life threatening injuries.