Selective fecal diversion in complex open pelvic fractures from blunt trauma.


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 1 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.


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