Management of delayed vertically unstable pelvic fractures

Abstract EN

Background : current treatment protocols for surgical intervention in unstable pelvic fractures recommend early fixation.

For some reasons, patients are referred late after trauma, and surgery imposes difficulties to the patient and the surgeon.

Patients and methods: This study represents a case series of 16 patients with vertically unstable pelvic fractures who presented 3 weeks or more after the initial trauma to Assiut University Hospital during a period of five years.

Time since injury averaged 7 weeks (range 3-32 weeks).

There were 14 males and 2 females.

Age of the patients averaged 28 years.

There were twelve unilateral and four bilateral type-C pelvic fractures.

The posterior injury was iliac bone fracture in 5 patients, sacroiliac joint disruption in 5 and sacral fracture in 10.

The anterior injury was symphyseal disruption in 9 patients, pubic rami fracture in 6, and combined pubic rami fracture and symphyseal disruption in one patient.

Seven patients had neurologic injuries.

Combined posterior and anterior pelvic ring fracture fixation was done in 9 patients.

Posterior pelvic fixation alone was done in 1 patient.

Radiographic assessment of reduction was done according to Matte and Torn Etta, and functional assessment was done using Majored score.

The mean postoperative follow up was 31 months.

Results : all fractures healed.

Complications included transient L5 palsy (n = l), ilio-femoral DVT (n = l), early metal failure (n-2).

Postoperative fracture displacement averaged 5 mm (range 1-19 mm).

Fracture reduction was considered excellent in 11 patients (69 %), good in four patients (25 %), and fair in one patient (6 %).

Limb length discrepancy ranged from 0-17 mm (average 4 mm).

Functional result was excellent in 12 patients (75 %), good in three patients (18.75 %) and fair in one patient (6.25 %).

Conclusions: this study supports planned surgical intervention for delayed vertically unstable pelvic fractures.

Rules of inter-hospital referral should impose early transfer of patients to avoid the additional difficulties of late fixation.