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• W2065012979 abstract "Open pelvic fractures are rare but severe injuries and a mortality rate between 6% and 70% has been reported. Even though these injuries are usually part of polytrauma, up to half of them die due to their pelvic injuries (acute haemorrhage and late sepsis). 1 Davidson B.S. Simmons G.T. Williamson P.R. Buerk C.A. Pelvic fractures associated with open perineal wounds: a survivable injury. J Trauma. 1993; 35: 36-39 Crossref PubMed Scopus (72) Google Scholar , 2 Hanson P.B. Milne J.C. Chapman M.W. Open fractures of the pelvis. J Bone Joint Surg [Br]. 1991; 73: 325-329 PubMed Google Scholar , 3 Maull K. Sochatello C.R. Ernst C.B. The deep perineal laceration – an injury frequently associated with open pelvic fractures: a need for aggressive surgical management. A report of 12 cases and review of the literature. J Trauma. 1977; 17: 685-696 Crossref PubMed Scopus (83) Google Scholar , 4 Richardson J.D. Harty J. Amin M. Flint L.M. Open pelvic fractures. J Trauma. 1982; 22: 533-538 Crossref PubMed Scopus (101) Google Scholar , 5 Sinnott R. Rhodes M. Brader A. Open pelvic fractures: an injury for trauma centres. Am J Surg. 1992; 163: 283-287 Abstract Full Text PDF PubMed Scopus (38) Google Scholar The open nature of the injury increases the chances of significant fracture site uncontrolled bleeding and pelvic contamination. 6 Dente C.J. Feliciano D.V. Rozycki G.S. Wyrzykowski A.D. Nicholas J.M. Salomone J.P. et al. The outcome of open pelvic fractures in the modern era. Am J Surg. 2005; 190: 830-835 Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar Approximately in one-third of the patients who die of open pelvic fractures mortality is related to sepsis from an infectious source in the pelvis. 7 Woods R.K. O’Keefe G. Rhee P. Routt Jr., M.L. Maier R.V. Open pelvic fracture and faecal diversion. Arch Surg. 1998; 133: 281-286 Crossref PubMed Scopus (44) Google Scholar The prevention or control of post-injury sepsis in open pelvic fractures is a controversial topic. Historically, faecal diversion has been regarded as an obligatory procedure to minimise infectious complications associated with open pelvic fractures. 2 Hanson P.B. Milne J.C. Chapman M.W. Open fractures of the pelvis. J Bone Joint Surg [Br]. 1991; 73: 325-329 PubMed Google Scholar , 3 Maull K. Sochatello C.R. Ernst C.B. The deep perineal laceration – an injury frequently associated with open pelvic fractures: a need for aggressive surgical management. A report of 12 cases and review of the literature. J Trauma. 1977; 17: 685-696 Crossref PubMed Scopus (83) Google Scholar , 4 Richardson J.D. Harty J. Amin M. Flint L.M. Open pelvic fractures. J Trauma. 1982; 22: 533-538 Crossref PubMed Scopus (101) Google Scholar , 8 Kusminsky R.E. Shbeeb I. Makos G. Boland J.P. Blunt pelvic-perineal injuries: an expanded role for the diverting colostomy. Dis Colon Rectum. 1982; 25: 787-790 Crossref PubMed Scopus (32) Google Scholar , 9 Raffa J. Christensen N.M. Compound fractures of the pelvis. Am J Surg. 1976; 132: 282-286 Abstract Full Text PDF PubMed Scopus (51) Google Scholar The principle of faecal diversion is based on the risk of chronic faecal soiling of a wound that is in continuity with a pelvic fracture. A pelvic haematoma and devitalised tissue in proximity of fracture fixation hardware further increase infection risk. Due to the low incidence and the complexity of these cases, there is no strong scientific evidence to support this concept. 9 Raffa J. Christensen N.M. Compound fractures of the pelvis. Am J Surg. 1976; 132: 282-286 Abstract Full Text PDF PubMed Scopus (51) Google Scholar , 10 Lunsjo K. Abu-Zidan F.M. Does colostomy prevent infection in open blunt pelvic fractures? A systematic review. J Trauma. 2006; 60: 1145-1148 Crossref PubMed Scopus (30) Google Scholar , 11 Pell M. Flynn W.J. Seiber R.W. Is colostomy always necessary in the treatment of open pelvic fractures?. J Trauma. 1998; 45: 371-373 Crossref PubMed Scopus (41) Google Scholar Stomas themselves are associated with significant mortality and morbidity in trauma patients. 10 Lunsjo K. Abu-Zidan F.M. Does colostomy prevent infection in open blunt pelvic fractures? A systematic review. J Trauma. 2006; 60: 1145-1148 Crossref PubMed Scopus (30) Google Scholar , 12 Caricato M. Ausania F. Ripetti V. Bartolozzi F. Campoli G. Coppola R. Retrospective analysis of long-term defunctioning stoma complications after colorectal surgery. Colorectal Dis. 2007; 9: 559-561 Crossref PubMed Scopus (74) Google Scholar In 1994, Faringer described a selective management for faecal diversion in open pelvic fractures depending on the region of the wound. 13 Faringer P.D. Mullins R.J. Feliciano P.D. Duwelius P.J. Trunkey D.D. Selective fecal diversion in complex open pelvic fractures from blunt trauma. Arch Surg. 1994; 129: 958-964 Crossref PubMed Scopus (59) Google Scholar Other studies also have reported selective management for faecal diversion based on wound location. 6 Dente C.J. Feliciano D.V. Rozycki G.S. Wyrzykowski A.D. Nicholas J.M. Salomone J.P. et al. The outcome of open pelvic fractures in the modern era. Am J Surg. 2005; 190: 830-835 Abstract Full Text Full Text PDF PubMed Scopus (67) Google Scholar , 7 Woods R.K. O’Keefe G. Rhee P. Routt Jr., M.L. Maier R.V. Open pelvic fracture and faecal diversion. Arch Surg. 1998; 133: 281-286 Crossref PubMed Scopus (44) Google Scholar , 8 Kusminsky R.E. Shbeeb I. Makos G. Boland J.P. Blunt pelvic-perineal injuries: an expanded role for the diverting colostomy. Dis Colon Rectum. 1982; 25: 787-790 Crossref PubMed Scopus (32) Google Scholar , 9 Raffa J. Christensen N.M. Compound fractures of the pelvis. Am J Surg. 1976; 132: 282-286 Abstract Full Text PDF PubMed Scopus (51) Google Scholar , 11 Pell M. Flynn W.J. Seiber R.W. Is colostomy always necessary in the treatment of open pelvic fractures?. J Trauma. 1998; 45: 371-373 Crossref PubMed Scopus (41) Google Scholar , 14 Grotz M.R. Allami M.K. Harwood P. Pape H.C. Krettek C. Giannoudis P.V. Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury. 2005; 36: 1-13 Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar" @default.
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• W2065012979 title "Selective faecal diversion in open pelvic fractures: Reassessment based on recent experience" @default.
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