Pelvic fractures due to falls from a height in people with mental disorders

doi:10.1016/j.injury.2008.03.012

Injury

Volume 39, Issue 8, August 2008, Pages 881-888

https://doi.org/10.1016/j.injury.2008.03.012 Get rights and content

Summary

Background

Pelvic fracture resulting from a fall, is a serious condition with morbidity and mortality that are higher among people with mental disorders.

Methods

A retrospective study of fall pelvic fractures 1999–2006, comparing clinical features of cases with and without mental disorders.

Results

Of 248 participants, 69 had comorbid mental disorder, sustained worse injuries requiring more treatment, and displayed injury recidivism.

Conclusion

A strategy of injury prevention is vital in the subsequent management of these patients.

Introduction

Falls from a height are a major cause of significant blunt trauma with high morbidity and mortality rates.8, 21 These falls have a distinct mechanism of blunt trauma, namely vertical deceleration; the force is commonly transmitted throughout the axial skeleton and soft tissues. The injuries sustained from falls thus constitute a unique form of blunt trauma with a unique distribution of damage,25, 28, 29 characterised by multiple lesions in many body areas. Fractures are the most common, followed by varying degrees of head, thoracic, intraabdominal and retroperitoneal injury. The nature and prognosis of the trauma depend on the height of fall, the leading part of the casualty's body, the terrain at the impact site and the age of the casualty.1, 6, 12 Knowledge of such features may help in the evaluation and treatment of fall victims by focusing on specific problems.

Pelvic fractures have been recognised as serious conditions and are often associated with damage to other important organs due to the high-energy impact.¹⁰ Because of the intimate relationship between the pelvis and related vasculature, a fractured pelvis may be associated with significant haemorrhage from both the bones themselves and from the disrupted vasculature. Management of these cases can be very challenging, necessitating prompt triage and definitive treatment. The basic principle of the multidisciplinary approach includes control of haemorrhage, restoration of haemodynamics and rapid identification and treatment of associated life-threatening injuries.7, 13, 17

Recent studies have shown that mental disorders are common among trauma victims.11, 26, 33 The presence of mental disorder complicates the clinical course and outcome of pelvic fractures, e.g. of people who have fallen. However, the impact of mental disorders on specific injuries has seldom been discussed. The purpose of this study was to investigate the effects of mental disorders on the clinical features and outcomes of pelvic fractures due to falls, and to analyse the risk of injury recidivism among people with mental disorders.

Section snippets

Materials and methods

During a 7-year period between July 1999 and June 2006, 1454 people with pelvic fractures were admitted to Chang-Gung Memorial Hospital, a level I trauma centre. Patients referred from other hospitals for definitive treatment of pelvic fractures and those who died in the emergency department were excluded, leaving 1354 casualties for further study. In 248 cases the mechanism of injury was a fall from a height. These cases comprised our series and, for comparison, were divided into those without

Injury features and treatment in both groups

In total 248 pelvic fractures due to free falls were studied. The mean fall height was 6.6 m (range, 1.8–33.8 m). The fall height was more than 6.2 m in 132 cases (53%), and more than 12.3 m in 32 cases (13%). The fall height significantly correlated with the injury severity score (ISS; r = 0.413, p < 0.001), blood transfusion amount (r = 0.419, p < 0.001) and length of hospital stay (r = 0.317, p < 0.001). Casualties’ initial haemoglobin levels had a negative correlation with fall height (r = −0.254, p < 0.001).

Results of treatment

Overall, there were 14 deaths (6%). Early death (3 days after admission; 6 cases) was usually due to exsanguinating haemorrhage and head injury, and late death (8 cases) due to sepsis or multiple organ failure. As shown in Table 1, people with mental disorders had significantly higher mortality and morbidity rates; six individuals committed suicide because of acute psychological stress, and two with major depression died during treatment.

Psychiatric consultation took place in the emergency

Discussion

The majority of previous reports on high-level falls were from forensic data. For trauma surgeons, the challenges lie with those who survive their falls, and in our study most victims survived. Urban free falls differ from bridge and rural free falls; many of our casualties struck architectural ledges or fell onto hard-impact sites, which modified injury mechanisms. Urban free falls tend to result in severe pelvic, lower-extremity and spinal fractures.²⁹ Pelvic fracture has been recognised as a

Conclusion

The height of fall correlates well with injury severity and morbidity. The presence of mental disorders complicates the clinical course and results of treatment of pelvic fractures due to falls. Psychiatric consultation should take place as soon as possible. People with mental disorders have a high risk for injury recidivism, and good preventive strategy is of utmost importance in subsequent management.

Conflict of interest

None.

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Psychiatric illness is a risk factor for increased complications, particularly in pelvic ring injuries. Fang et al. noted a significant increase in complications in a cohort of 248 pelvic fractures from 36% in the control group to 54% in the psychiatric illness group [21]. Also noted was the increased hospital length of stay, ICU stay, mortality, and repeat injury in the psyiatric illness group.
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Falls from height are a common cause of death and disability. Falls from height can be divided between accidental and suicide attempts. The aim of this study is to ascertain the demographic characteristics of these patients, and to identify the fracture patterns.
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Pelvic fractures due to falls from a height in people with mental disorders

Summary

Background

Methods

Results

Conclusion

Introduction

Section snippets

Materials and methods

Injury features and treatment in both groups

Results of treatment

Discussion

Conclusion

Conflict of interest

Injury

Surg Clin North Am

J Am Coll Surg

J Am Coll Surg

Schizophr Res

Arch Surg

Clin Radiol

Factors effecting mortality in urban vertical free falls: evaluation of 180 cases

Int Surg

Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage

J Trauma

The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care

J Trauma

Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures

Ann Surg

Jumping from the Westgate Bridge, Melbourne

Med J Aust

High-level falls: type and severity of injuries and survival outcome according to age

J Trauma

The importance of fracture pattern in guiding therapeutic decision-making in patients with haemorrhagic shock and pelvic ring disruptions

J Trauma