Original reportThe Significance of Penetrating Gluteal Injuries: An Analysis of the Operation Iraqi Freedom Experience
Introduction
Penetrating gluteal injuries are an uncommon source of trauma in both civilian trauma centers and battlefield environments, accounting for approximately 2% to 3% of all traumatic injuries.1, 2 They have not been well studied in the surgical literature or documented in past wars, with most series consisting of retrospective reviews and small case series.3, 4 With a wide variety of mechanisms ranging from gunshot and stab wounds to impalement or blast injuries, these injuries present a diagnostic difficulty, as they may often falsely appear benign on initial evaluation or have an ambiguous depth or trajectory.4, 5, 6 Yet, adjacent visceral and vascular structures located in close proximity to one another in the fixed pelvis and abdominal cavity are at significant risk for concomitant injury from either the inciting object or the pelvic injury causing secondary damage. Failure of the physician to appreciate their potential for accompanying injury can therefore result in serious morbidity and mortality. The purpose of this study is to identify and analyze the clinical outcomes and factors affecting the management from a cohort of patients suffering penetrating gluteal injury in the modern combat environment.
Section snippets
Methods
After approval by the Joint Theatre Trauma Registry institutional review board, we queried the prospectively collected data from all US, coalition, and local national patients injured and treated at a combat support hospital during Operation Iraqi Freedom over a 16 month period and identified all patients sustaining penetrating gluteal injuries. Patients with cutaneous or superficial tangential abrasion injuries were excluded. We collected data pertaining to patient demographics, injury
Results
From the 3442 patients treated, 115 (3.3%) sustained penetrating gluteal injuries. See Table 1 for patient demographics. The cohort included 59 (51%) US and coalition forces and 56 (49%) Iraqi national and enemy troops. They were predominantly young men (n = 113, 98%), 28 ± 10.9 years (range, 6-70). They presented with moderate-to-severe physical insult as evidenced by an injury severity score (ISS) of 13 ± 15 (range, 1-75), and 15% (n = 17) having an ISS greater than 20 on arrival. They had a
Discussion
Our study sought to identify factors affecting the management and outcome of patients sustaining penetrating gluteal trauma in a population injured during our most recent wartime conflict. Our data revealed a high rate of associated injuries, including injuries to major vascular and visceral structures in the pelvis and abdomen, in patients presenting with penetrating gluteal injury. By examining demographics, methods of evaluation and treatment, as well as incidence and types of associated
Conclusion
In sum, associated injuries sustained with penetrating gluteal trauma are a consequence of the proximity and fixed nature of vital organs in the pelvis, with those in the trajectory path at greatest risk. Our study identified a high rate of concomitant injuries with associated morbidity and mortality in patients presenting with wounds to the gluteal region. In addition to significant damage to local structures, gunshot wounds carry a higher risk of injury to the rectum while blast injuries are
References (24)
- et al.
The use of damage-control principles for penetrating pelvic battlefield trauma
Am J Surg
(2006) - et al.
Management of civilian extraperitoneal rectal injuries
Asian J Surg
(2006) - et al.
An analysis of proctoscopy vs. computed tomography scanning in the diagnosis of rectal injuries in children: which is better?
J Pediatr Surg
(2006) - et al.
Gluteal gunshot wounds: who warrants exploration?
J Trauma
(1994) - et al.
Abdomino-pelvic-gluteal war injuriesPrinciples of treatment
Ann Urol
(1997) Gluteal gunshot wounds
Mil Med
(2000)- et al.
Penetrating injury to the gluteal region
J Trauma
(1992) - et al.
Anatomic considerations in penetrating gluteal wounds
Arch Surg
(1992) - et al.
Penetrating gluteal injuries
J Trauma
(1982) - et al.
Stab wounds to the gluteal region: a management strategy
J Trauma
(2001)