Blast-Related Pelvic Fractures

Blast injuries to the pelvis are uncommon but devastating injuries typically associated with lower extremity amputations, intra-abdominal injuries, and genitourinary trauma. The majority of patients with a blast-injured pelvis will die at the point of injury. Maximizing chances of survival depends on rapid hemodynamic stabilization through the use of a pelvic binder or external fixator, resuscitation with crystalloids and blood products, and often pelvic packing or proximal arterial control. Once hemodynamically stable, debridement of traumatic wounds is challenging due to the multiple potential spaces of the open pelvis. Patients with a blast-injured pelvis are at high risk of both bacterial and fungal deep space infections. Antibiotic-impregnated beads and negative pressure wound therapy are useful adjuncts in preventing or mitigating infection. Late reconstructive care relies on local flaps of opportunity and the use of regenerative medicine adjuncts such as dermal regeneration templates. Survivors typically require extensive rehabilitation but are usually able to regain the ability to function independently.