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Pelvic Ring Injury: Should We Notice Acid-Base Imbalance as Mortality Predictor?

Introduction. Young-Burgess classification system for pelvic ring fracture is popular because it is theoretically a mechanistic classification that is able to predict mortality. The inherent usefulness has led to its widespread use by both orthopaedic and general surgeon in guiding treatment. It can also predict associated injuries and the severity of hemorrhagic shock. Severe hemorrhagic shock will cause hypoperfusion of tissues which may lead to metabolic acidosis, one among the triad of death. Materials and methods. Medical records of pelvic ring injury patients in Department of Orthopaedic and Traumatology Hasan Sadikin Hospital, Bandung during 2010 were retrospectively reviewed. Data about age, gender, mechanism of injury, Young-Burgess classification, base excess, lactate concentration, pH, and outcome in 24 hours were extracted. Non-parametric Kendall-Tau analysis was used to analyze the correlation among Young-Burgess classification and hemorrhagic shock class, base excess, lactate concentration, pH, and outcome in 24 hours. Kruskal-Walis test was used to determine the difference among Young-Burgess classification and hemorrhagic shock class, base excess, lactate concentration, pH, and outcome in 24 hours Results. There were significant correlation between Young-Burgess classification and severity of hemorrhagic shock (p<0.01), haemoglobin (p<0.01), pH (p<0.01), and mortality (p<0.01). There were significant correlation between stability of fracture and hemorrhagic shock class (p<0.05), haemoglobin (p<0.05), pH (p<0.05), and mortality (p<0.01). Conclusions. stability of fracture, severity of hemorrhagic shock, and acid-base imbalance will lead to higher mortality. Keywords: acid-base imbalance, Young-Burgess classification, mortality, pelvic ring injury