Combat Pelvic Injuries and Hip Dislocations

Abstract

Combat injuries to the pelvic ring and acetabulum have traditionally carried high mortality rates. Improvements in acute casualty care, a more efficient medevac system, damage control resuscitation techniques, and trained orthopedic surgeons downrange can contribute to increasing survival rates for those patients wounded with pelvic injuries. Nonetheless, the combat environment contributes various elements that can delay or limit care and ultimately contribute to critically unstable patients or even mortality. Deployed orthopedic surgeons can expect a variety of stable and unstable pelvic ring and/or acetabular fracture patterns caused by either traditional blunt trauma or blast mechanisms of injury. The downrange orthopedic care of pelvic injuries is limited by the austere operating environment and a lack of surgical resources. The initial treatment priorities focus on acute resuscitation, hemorrhage control, provisional pelvic ring stabilization or femoroacetabular reduction, and the identification and treatment of associated injuries. This damage control algorithm allows for stable patient movement out of the combat theater for later definitive fracture fixation.