Patterns and management of pelvic ring fractures at Moi Teaching and Referral Hospital, Eldoret

Abstract

Background: Pelvic ring fractures constitute a disruption of the bony and soft tissue pelvis. They are associated with significant morbidity and mortality. The morbidity includes associated injuries, increased and frequent complications, prolonged hospitalization and attendant hospital costs. Records review indicate increasing trend at MTRH. While management of these injuries is routinely undertaken at MTRH no study has been done to determine level of burden, patterns of injuries and describe the management of such injuries. This is even so important considering the paucity of studies on this subject in the country. Objective: To determine pattern and management of pelvic ring fractures at the Moi Teaching and Referral Hospital. Methods: A prospective descriptive study for a period of 18 months from 1st January 2014 to 30th September 2015. Data was collected using predesigned interviewer administered questionnaire for a period of 12 weeks from admission to document management, length of hospital stay, complications and ambulation at discharge. Results: The burden of injuries was 1.7%, with Road Traffic Accidents being the most frequent cause (80%). Fracture patterns according to Tile classification were Type A (61%), Type B (21%) and Type C (19%). Associated injuries were observed in 55%. Nonoperative management was done in 68% with operative stabilization in 29%.Average Length of Hospitalization was 18 ± 2.5(SEM) days with complications noted as Deep SSI in 1 patient(8%,n=13), DVT in 1 patient(2%, n=51), Pin Site Infection in 1 patient and death in two patients (4%, n=51). Conclusion: The burden of pelvic ring fractures at MTRH Orthopaedic wards was found to be 1.7%. Tile A fracture pattern was the commonest pelvic ring injury caused by Road Traffic Accidents. Most pelvic ring fractures were managed nonoperatively. Associated injuries occurred in over half of the patients while complications were observed in six patients. Recommendations: High index of suspicion for associated injuries, awareness and focus on prevention of complications such as DVT, deep SSI, Pin Site Infection and death among patients with pelvic ring fractures and enhancement of efforts to prevent motor vehicle accidents to reduce on the occurrence of pelvic ring fractures.