The impact of external fixation on mortality in patients with an unstable pelvic ring fracture: a propensity-matched cohort study
2018
Aim There is not adequate evidence to establish whether external
fixation (EF) of pelvic fractures leads to a reduced mortality.
We used the Japan Trauma Data Bank database to identify isolated
unstable pelvic ring fractures to exclude the possibility of blood
loss from other injuries, and analyzed the effectiveness of EF on
mortality in this group of patients. Patients and Methods This was a registry-based comparison of 1163 patients who had
been treated for an isolated unstable pelvic ring fracture with
(386 patients) or without (777 patients) EF. An isolated pelvic
ring fracture was defined by an Abbreviated Injury Score (AIS) for
other injuries of < 3. An unstable pelvic ring fracture was defined
as having an AIS ≥ 4. The primary outcome of this study was mortality.
A subgroup analysis was carried out for patients who required blood
transfusion within 24 hours of arrival in the Emergency Department
and those who had massive blood loss (AIS code: 852610.5). Propensity-score
matching was used to identify a cohort like the EF and non-EF groups. Results With the use of propensity-score matching using the completed
data, 346 patients were matched. When the propensity-score matching
was adjusted, EF was associated with a significantly lower risk
of death (p = 0.047). In the subgroup analysis of patients who needed
blood transfusion within 24 hours and those who had massive blood loss,
EF was associated with a significantly lower risk of death in patients
who needed blood transfusion within 24 hours (p = 0.014) and in
those with massive blood loss (p = 0.016). Conclusion The use of EF to treat unstable pelvic ring fractures was associated
with a significantly lower risk of death, especially in patients
with severe fractures. Cite this article: Bone Joint J 2018;100-B:233–41.
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