Pattern of organ injuries in pelvic fracture: impact force implications for survival and death in motor vehicle injuries.

The direction of force impact, lateral or frontal crash force, was estimated from the mechanism of pelvic fracture (PF) and related to the pattern of organ injuries, physiologic consequences, and outcomes in 197 motor vehicle accident (MVA) patients who had all sustained a PF. These data showed that injuries due to anterior-posterior compression (APC) (frontal crashes) were associated with injuries of major severity to the bony pelvis with major retroperitoneal bleeding and massive volume loss shock. Death in the APC patient was frequently due to a late complication of the shock: sepsis, adult respiratory distress syndrome (ARDS), or lung infection. However, in lateral compression (LC) injuries (lateral crashes) with fatal outcomes, there was a significant increase in severe brain injuries and a rise in lung and upper abdominal visceral injuries with relatively minor PF. These data suggest the great vulnerability of the MVA patient, driver or passenger, to lateral crash forces and suggest important areas for occupant protection.