September 1994

Selective Fecal Diversion in Complex Open Pelvic Fractures From Blunt Trauma

Author Affiliations

From the Divisions of General Surgery (Drs Faringer, Mullins, Feliciano, and Trunkey) and Orthopedic Surgery (Dr Duwelius), Department of Surgery, Oregon Health Sciences University, Portland.

Arch Surg. 1994;129(9):958-964. doi:10.1001/archsurg.1994.01420330072014

Objective:  To review the outcomes of patients with open pelvic fractures.

Design:  Retrospective review of medical records.

Setting:  Patients admitted from the injury scene or transferred within 24 hours to a level I trauma center.

Patients:  Thirty-three patients sustaining blunt trauma had pelvic fractures and adjacent wounding.

Interventions:  Treatment protocol that included selective fecal diversion, measures to arrest hemorrhage and prevent wound sepsis, manage associated pelvic injuries, and provide optimal orthopedic outcomes.

Main Outcome Measures:  Death and sepsis.

Results:  Exsanguination occurred in one patient and death owing to head injuries occurred in five patients. Wound sepsis occurred in 31% of patients with colostomy and 19% without colostomy.

Conclusions:  Management of open pelvic fractures requires a well-coordinated group using several techniques. Selected patients with open pelvic fractures do not require fecal diversion. Incisions for orthopedic surgery should be considered when decisions are made regarding fecal diversion.(Arch Surg. 1994;129:958-964)