The Significance of Penetrating Gluteal Injuries: An Analysis of the Operation Iraqi Freedom Experience

• Published in: Journal of surgical education Vol. 65; no. 1; pp. 61 - 66
• Main Authors: Lesperance, Kelly, MD, Martin, Matthew J., MD, Beekley, Alec C., MD, Steele, Scott R., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2008
• Subjects: Adolescent; Adult; Buttocks - injuries; Cause of Death; Cohort Studies; Female; gluteal; Humans; Injury Severity Score; Iraq War, 2003-2011; Male; Medical Knowledge; Middle Aged; Military Personnel; Multiple Trauma - diagnosis; Multiple Trauma - mortality; Multiple Trauma - surgery; OIF; Patient Care; penetrating injuries; Practice Based Learning and Improvement; Probability; rectal trauma; Rectum - injuries; Retrospective Studies; Risk Assessment; Surgery; Survival Analysis; Systems Based Practice; Wounds, Gunshot - diagnosis; Wounds, Gunshot - mortality; Wounds, Gunshot - surgery; Wounds, Penetrating - diagnosis; Wounds, Penetrating - mortality; Wounds, Penetrating - surgery; Young Adult; Patient Care; rectal trauma; Medical Knowledge; Systems Based Practice; gluteal; Practice Based Learning and Improvement; penetrating injuries; OIF
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2007.08.004

Background Although penetrating gluteal injuries rarely are life-threatening, the risk for concomitant injury to regional anatomic structures warrants additional evaluation. We analyzed factors affecting the management and outcomes of these injuries. Methods Retrospective analysis of prospectively collected data from the 31st Combat Support Hospital during Operation Iraqi Freedom over a 16 month period. Results From 3442 patients, 115 patients (3.3%) suffered penetrating gluteal injuries. They were predominately male (98%) with a mean injury severity score of 13. Mortality was 6% (n = 7). Primary mechanisms of injury were improvised explosive devices (41%) and gunshot wounds (59%). Associated injuries were present in 57% of patients [orthopedic (35%), abdominal (29%), rectal (25%), vascular (21%), genitourinary (14%), pulmonary (11%), sphincter (9%)]. Overall, 76% required surgical management, with 14% developing postoperative complications. In total, 27 patients (24%) required stoma placement. Gunshot wounds were associated with through and through injuries (43% vs 6%, p < 0.01), rectal injury (35% vs 11%, p < 0.05), and stoma placement (32% vs 11%, p < 0.05). Blast injuries were associated with a higher mean transfusion requirement (11 vs 6 units, p < 0.05), increased length of stay (14 vs 9 days, p < 0.05), and traumatic brain injury (24% vs 6%, p < 0.05). Independent predictors of a need for stoma placement were gunshot wounds (odds ratio = 10, p < 0.05) and injury severity score greater than 20 (odds ratio = 27, p < 0.01). Conclusions Penetrating gluteal injuries are associated with significant damage to local structures. Gunshot wounds carry a higher risk of injury to the rectum and stoma placement, whereas blast injuries are associated with less local injury and more multisystem trauma.