The Effect of Orthopaedic Injuries on Morbidity and Mortality in Traumatic Aortic Disruption

Abstract

Objective: Traumatic rupture of the aorta is known to be associated with high-energy deceleration injuries including head, abdominal and musculoskeletal trauma. The purpose of this study was to identify common associated orthopaedic injuries and their effect on mortality and morbidity in patients sustaining blunt aortic injury (BAI). Patients and Methods: We reviewed the medical records, autopsy reports and X-rays of all patients with a diagnosis of traumatic aortic injury entered into the Trauma Registry and identified by ICD 9 codes at the author's institution between July 1988 and July 1999. One-hundred and four patients were identified, of which 88 sustained injuries secondary to blunt trauma (BAI) and comprise the focus of our study. Results: Overall mortality was 47.7 % (42/88). Forty-six of fifty-four patients who received emergency aortic repair survived (85.2 %). Sixty-three of eighty-eight patients (71.5 %) had associated orthopaedic injuries and 28 of the 42 deaths (66.6 %) occurred in this group. A significant impact on morbidity and mortality was observed. Conclusions: Orthopaedic pathologies in patients with BAI share similar mechanisms of injury. Fractures of the spine and pelvis are frequently associated with BAI and can serve as vital diagnostic markers to alert physicians caring for these patients in the emergency room and trauma centres. Pelvic disruption and long bone fractures associated with haemorrhagic shock should be prioritised and selectively stabilised rapidly prior to aortic repair.

blunt aortic injury (BAI) - associated orthopaedic injuries - compartment syndrome - injury patterns - regional mortality

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