Immediate spica casting for pelvic fractures.
Records of 52 polytraumatized patients with closed pelvic fractures were reviewed retrospectively to determine if spica cast application decreased mortality due to exsanguination. Twelve patients had supplemental stabilization with external fixators or internal fixation of the pelvis. Their results indicated that the spica cast is effective in decreasing or controlling bleeding since no patient died of exsanguination. Several patients did die, however, but the cause of death in these patients was usually adult respiratory distress syndrome with or without other sepsis. Injury severity score, age, hypotension, and platelet count were found to be prognostic indicators for both transfusion requirements and mortality. A spica cast may be a useful adjunctive method for decreasing blood loss in the immediate postinjury period, but prolonged or improper use may lead to additional complications and death.