International Journal of Health Sciences & Research (www.ijhsr.org) 103 Vol.4; Issue: 9; September 2014 International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Pelvic Fracture - A Retrospective Autopsy Study A. G. Vijay Kumar1, S. Shiva Prakash2 1Assistant Professor, Dept of Forensic Medicine & Toxicology, Adhichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India. 2Lecturer, Dept of Anatomy, JSS Medical College, Mysore. Corresponding Author: A. G. Vijay Kumar Received: 04/07//2014Revised: 29/07/2014 Accepted: 20/08/2014 ABSTRACT Introduction: The pelvis is a ring-like structure of bones at the lower end of the trunk. The two sides of thepelvisareactuallythreebones(ilium,ischium,andpubis)thatgrowtogetheraspeopleage.Strong connective tissues (ligaments) join the pelvis to the large triangular bone (sacrum) at the base of the spine. Materialandmethods:Inthisretrospectivestudy,fatalcasesofpelvictraumaautopsiedduringthe period 1st January 2011 to 31st December 2013 were analyzed at the Department of Forensic Medicine & Toxicology,AIMS,BGNagar,Karnataka.Duringthisstudyseveralepidemiologicalobservationsand their results were considered. Results and Discussion: In our study total numbers of autopsied cases during 2011 to 2013 are 323. In that 50 (15%) cases had pelvic fracture. Maximum number of victims belongs to 21-30 years (19 cases; 38%)decadefollowedby 41-50years(12 cases; 24%). Thevictimsin most of thecases sustainedroad traffic accidental injuries (43 cases; 86%) followed by fall from height (07 cases; 14%). Conclusion:Pelvicfracturescanbedangeroustoonesphysicalhealth.Asthehumanbodyages,the bones becomemore weak and brittle and are therefore more susceptible to fractures. Certain precautions arecrucialinordertolowertheriskofgettingpelvicfractures.Thiscanbeverydangerousbecause the pelvis supports many internal organs and can damage these organs. Key words: Pelvic fracture, Road traffic accident, Falls from height. INTRODUCTION Thepelvisisaring-likestructureof bones at the lower end of the trunk. The two sidesofthepelvisareactuallythreebones (ilium,ischium,andpubis)thatgrow togetheraspeopleage.Strongconnective tissues(ligaments)jointhepelvistothe large triangular bone (sacrum) at the base of thespine.Thiscreatesabowl-likecavity belowtheribcage.Oneachside,thereisa hollowcup(acetabulum)thatservesasthe socket for the hip joint. Theincidenceofpelvicfracturesin theUnitedStateshasbeenestimatedtobe 37casesper100,000person-years.The incidenceofpelvicfracturesisgreatestin people aged 15-28 years. In persons younger than35years,malessustainmorepelvic fractures than females; in persons older than 35years,womensustainmorepelvic fracturesthanmen.Mostpelvicfractures International Journal of Health Sciences & Research (www.ijhsr.org) 104 Vol.4; Issue: 9; September 2014 thatoccurinyoungerpatientsresultfrom high-energymechanisms,whereaspelvic fracturessustainedintheelderlypopulation occurfromminimaltrauma,suchasalow fall. [1]Pelvicfracturesrepresent3%to6% ofallfracturesinadultsandoccurinupto 20% of all polytrauma cases. They display a bimodaldistributionofagewithmost injuries occurring in the age ranges 15 to 30 andover60years;upto75%ofallpelvic injuries occur in men. [2]

Unstablepelvicfractureisestimated tooccurinupto20%ofpelvicfractures;a further22%ofpelvicfractureswillremain stabledespitesignificantdamagetothe pelvicring.Theremaining58%ofpelvic fracturesarelessseriousretainingboth haemo-dynamic and structural stability. [3]

Theincidenceofpelvicfracture resultingfromblunttraumarangesfrom5- 11.9%;withobesepatientsmorelikelyto sustainapelvicfracturefromblunttrauma than non-obese patients. [4] Pelvicfractureassociatedwith penetrating trauma is far less frequent. Open pelvic fractures are rare and account for only 2.7 - 4% of all pelvic fractures. Themortalityfrompelvicfractures inpatientswhoreachhospitalisreportedto bebetween7.6%and19%. [5] Although exsanguinatinghaemorrhagefrompelvic fractureisofappreciableconcern,studies alsosuggestthattheassociatedabdominal andpelvicinjuriescausedbythepelvic fractureorfromothersysteminjuriesfrom theconsiderableenergytransferaccountfor thecauseofdeathinthesepatients.The mortality from open pelvic fractures is much higher and approaches 50%. [6] Hemorrhageisthecauseofdeathin 40%ofallpelvictraumavictimsandthe leadingcauseofdeath(60%offatalcases) inunstablepelvicfracture.Bleedingis usuallyretroperitoneal,thevolumeofblood losscorrelateswiththedegreeandtypeof pelvic disruption.Reportedmortalityratesrangefrom 6.4%to30%dependingonthetypeof pelvicfracture,haemodynamicstatus,and thenatureofconcomitantinjuriesandtheir complications. Themortalityrateamong haemodynamicallystablepatientsisaround 10%,whereasthemortalityrateamongst haemodynamicallyunstablepatients approaches 20-30% but has been reported to be as high as 50% in cases of unstable open fracture;combinedmortalityapproaches 16%. [7] MATERIALS AND METHODS In this retrospective study, fatal cases of pelvic trauma autopsied during the period 1stJanuary2011to31stDecember2013 were analyzed at the Department of Forensic Medicine & Toxicology, AIMS, B G Nagar, Karnataka.Duringthisstudyseveral epidemiologicalobservationsandtheir results were considered. RESULTS Table no-1: Incidence of pelvic fracture cases. TOTALNO.OFAUTOPSIED CASES TOTALNO.OFPELVIC FRACTURE CASES 32350 Table no-2: Age and Sex wise distribution of cases. Sr.no.Age groupNo.Of cases MaleFemaleTotal 1< 20 YRS03030003 221 30 YRS19160319 331- 40YRS09080109 441- 50 YRS12080412 5>50 YRS07040307 Total5050 Table no-3: Manner of Injury. MANNER OF INJURYNO.OF CASES PERCENTAGE ROAD TRAFFIC ACCIDENT4386% RIDER1632% DRIVER1224% PASSANGER0816% PEDESTRIAN0714% FALL FROM HEIGHT0714% International Journal of Health Sciences & Research (www.ijhsr.org) 105 Vol.4; Issue: 9; September 2014 DISCUSSIONInourstudytotalnumbersof autopsiedcasesduring2011to2013are 323.Inthat50(15%)caseshadpelvic fracture.Maximumnumberofvictims belongsto21-30years(19cases;38%) decadefollowedby41-50years(12cases; 24%).Thevictimsinmostofthecases sustainedroadtrafficaccidentalinjuries(43 cases; 86%) followed by fall from height (07 cases; 14%). Pelvicfracture isadisruptionofthe bonystructureofthe pelvis,including the hipbone, sacrum and coccyx.Themost commoncauseinelderlyisafall,butthe mostsignificantfracturesinvolvehigh-energyforcessuchasa motorvehicle accident,cyclingaccidents,orafallfrom significantheight.Becauseoftheforces involved, pelvic fractures frequently involve injurytoorganscontainedwithinthebony pelvis.Inaddition,traumatoextra-pelvic organs is common. Pelvic fractures are often associatedwithseverehemorrhagedueto the extensive blood supply to the region. Onespecifickindofpelvicfracture isknownasan'openbook'fracture.Thisis oftentheresultfromaheavyimpactto the groin(pubis),acommonmotorcycling accidentinjury.Inthiskindofinjury,the leftandrighthalvesofthepelvisare separated at front and rear, the front opening more than the rear, i.e. like opening a book. Dependingontheseverity,thismayrequire surgicalreconstructionbeforerehabilitation. Forcesfromananteriororposterior direction, like head-on car accidents, usually cause external rotation of the hemipelvis, an open-bookinjury.Openfractureshave increased risk of infection and hemorrhaging fromvesselinjury,leadingtohigher mortality. [8] AccordingtostudydonebyPoole GV, Pelvic hemorrhage has been implicated as the cause of death in 50% of patients who diefollowingpelvicfractures.Toestablish correlatesofmorbidityandmortalityfrom pelvicfracturesduetoblunttrauma,we reviewed 236 patients treated during 4 years. Theaverageageofthe144menand92 womenwas31.5years,theaverageInjury SeverityScorewas21.3,theaverageblood requirementwas5units,andtheaverage hospital stay was 16 days. [9] AccordingtostudydonebyPoole GV,almosttwothirdsofpatientswere injuredinmotorvehicleaccidents,and about one eighth were pedestrians struck by avehicle.Smallernumberswereinjuredin crushingaccidents,motorcycleaccidents, falls,andmiscellaneousinjuries.Only32 patients (9%) had an isolated pelvic fracture. Associatedinjuriestothehead,chest, abdomen,andupperandlowerextremities were frequent, and these injuries often had a greaterimpactonoutcomethanthepelvic fracture.Twenty-eightpatientsdiedan overallmortalityrateof8%.Onlyfour deaths(14.3%)wereadirectresultofthe pelvicfracture,andbleedingfroma transectedfemoralarterycontributedtoone of these deaths. Most deaths were caused by severeheadinjury,nonpelvichemorrhage, and multiple organ failure. [10] CONCLUSION Pelvicfracturescanbedangerousto onesphysicalhealth.Asthehumanbody ages,thebonesbecomemoreweak and brittle andarethereforemore susceptibleto fractures.Certainprecautions arecrucialinordertolowertheriskof gettingpelvicfractures.Thiscanbevery dangerousbecausethe pelvis supportsmany internalorgansandcandamagethese organs.Earlysuspicion,identificationand managementofapelvicfractureatthepre-hospitalstageareessentialforreducing bloodloss.Pelvicfractureisalsoamarker for considerable energy transfer and severity International Journal of Health Sciences & Research (www.ijhsr.org) 106 Vol.4; Issue: 9; September 2014 ofinjury,andthereforeallowsappropriate triage of the patient. REFERENCES 1.MeltonLJ3rd,SampsonJM,Morrey BF, Ilstrup D. Epidemiologic features of pelvicfractures. ClinOrthop.Mar-Apr 1981 ;( 155):43-7.2.GansslenA,PohlemannT,PaulC, Lobenhoffer P, Tscherne H, Gansslen A, etal.Epidemiologyofpelvicring injuries. Injury 1996; 27 :S-A13-20.3.HauschildO,StrohmPC,CulemannU, PohlemannT,SuedkampNP,Koestler W,etal.Mortalityinpatientswith pelvicfractures:resultsfromthe German pelvic injury register. Journal of Trauma-Injury Infection & Critical Care 2008;64(2):449-55.4.SalvinoCK,EspositoTJ,SmithD. et al Routine pelvic xray studies in awake blunttraumapatients:asensible policy? J Trauma.1992; 33413416. 5.PooleGV,WardEF,MuakkassaFF. et al Pelvicfracturefrommajorblunt trauma.Outcomeisdeterminedby associatedinjuries. AnnSurg. 1991;213538539. 6.RothenbergerDA,FischerRP,Strate RG. etal Themortalityassociatedwith pelvicfractures. Surgery.1978; 84356361. 7.HeetveldMJ,HarrisI,SchlaphoffG, BaloghZ,D'AmoursSK,SugrueM. Hemodynamicallyunstablepelvic fractures:Recentcareandnew guidelines.WorldJournalofSurgery 2004; 28(9):904-909. 8.Rothenberger,Velasco,Strate,Fischer,PerryJF."Openpelvic fracture: a lethal injury.". The Journal of trauma. 1978;18 (3): 1847. 9.PooleGV, WardEF, Muakkassa FF, HsuHS, GriswoldJA, RhodesRS. Pelvic fracture from major blunt trauma. Outcomeisdeterminedbyassociated injuries.AnnSurg. 1991Jun; 213(6):532-8. 10.PooleGV, WardEF.Causesof mortalityinpatientswithpelvic fractures.Orthopedics. 1994Aug; 17(8):691-6. ******************* How to cite this article: Vijay Kumar AG, Prakash SS. Pelvic fracture - a retrospective autopsy study. Int J Health Sci Res. 2014;4(9):103-106.