Failures in treating pelvic trauma

At its recent annual congress, the BOA set out the minimum standards needed in order to manage cases of pelvic and hip socket (acetabular) fracture. It said that patients with pelvis fractures, predominantly young people with multiple injuries caused by road traffic accidents, need prompt treatment in hospitals with specialist units but are frequently denied access.

The association pointed out that hospitals’ key targets are ensuring that patients are out of A&E within four hours and that planned elective surgery cases are not cancelled. This can mean that hospitals with specialist trauma teams cannot accept transferred patients with serious injuries or risk breaking their targets. The BOA claims that this causes trauma patients to remain “marooned” in an inappropriate hospital and suffer poor care and long delays in receiving an operation.

Mismanaged pelvic injuries can lead to death from haemorrhage and commonly results in major disability, while delayed surgery of fractures of the pelvic hip socket leads to avoidable osteoarthritis, hip damage and artificial joint replacement. Figures show that with prompt surgery, within five and seven days, 80% of patients with the most complex fractures can recover with excellent results, avoiding disability. Less than 50% can expect the same results after 10 days and almost no one after three weeks. Yet these delays are commonplace in the NHS, with hospitals reporting an average of between 10 and 20 days.

The British Orthopaedic Association and The Royal College of Surgeons have repeatedly called for the creation of a regional trauma network, where patients with complex, multiple injuries can be treated quickly.

Mr John Black, president of the Royal College of Surgeons, said: “We have been calling for a review of trauma services in the UK for many years. Evidence has been available since the mid 90s that shows that the treatment of pelvic and acetabular injuries was, and still is, inadequate. In the wake of Lord Darzi’s comprehensive review of the health service, I would urge the Department of Health to make a review of trauma services an urgent priority.”