Abstract
Severe military pelvic trauma has a high mortality rate with previous work identifying an association between pelvic fracture and traumatic amputation (TA) of the lower limb (LL). Research has also identified casualties with this combination of injuries as the potential ‘future unexpected survivors’, however, most casualties die early from exsanguination, often before medical interventions can be performed. Therefore targeting injury prevention or mitigation might be the route to increased survivorship. This study investigates this combination of injury and identifies targets for preventative techniques. A search of the JTTR from 2003 to 2014 identified all patients with TA and all pelvic fractures. Of 989 casualties with LL TAs, 19% had an associated pelvic fracture, and this was associated with a 56% mortality rate compared to 24% without. Both pubic symphysis and sacroiliac separation alike were associated positively with traumatic amputation (p < 0.01). The combination of pelvic instability and TA had a mortality rate of 52%. We hypothesise that pelvic fracture may share a mechanistic link with TA, meaning fracture may occur as a consequence of the force and direction of the TA, and it may be possible to direct mitigation strategies at this injury in order to improve survival rates.
