• M Caillot, E Hammad, M Le Baron, V Villes, M Leone, and X Flecher.
• Department of orthopedic and Trauma Surgery, hôpital Nord, chemin des Bourrely, 13015 Marseille, France. Electronic address: maximecaillot@gmail.com.
• Orthop Traumatol Sur. 2016 Dec 1; 102 (8): 1013-1016.

IntroductionSevere pelvic trauma remains associated with elevated mortality, largely due to hemorrhagic shock.ObjectiveThe main study objective was to test for correlation between fracture type and mortality. The secondary objective was to assess the efficacy in terms of mortality of multidisciplinary management following a decision-tree in multiple trauma victims admitted to a level 1 trauma center.Material And MethodsBetween July 2011 and July 2013, 534 severe trauma patients were included in a single-center continuous prospective observational study. All patients with hemorrhagic shock received early treatment by pelvic binder. Patients with active bleeding on full-body CT or persisting hemorrhagic shock underwent arteriography with or without embolization. Pelvic trauma was graded on the Tile classification. The principle end-point was mortality.ResultsMedian age was 40 years (range, 26-48 years), with a 79% male/female sex ratio. Thirty-two of the 67 patients with pelvic trauma (48%) were in hemorrhagic shock at admission. Median injury severity score (ISS) was 36 (range, 24-43). On the Tile classification, 22 patients (33%) were grade A, 33 (49%) grade B and 12 (18%) grade C. Overall mortality was 19%, and 42% in case of hemorrhagic shock. Mortality was significantly higher with Tile C than A or B (58% vs. 9.1% and 12.1%, respectively; P=0.001).ConclusionVertical shear fracture (Tile C) was associated with greater mortality from hemorrhagic shock.Level Of EvidenceIV, case series.Copyright © 2016 Elsevier Masson SAS. All rights reserved.

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