Abstract
Introduction Pelvic ring disruptions have well established biomechanical forces that correlate with fracture pattern. These patterns have considerable soft tissue and ligamentous disruptions associated with high velocity vectors which result in unstable injuries. This study critically evaluates the functional outcome of anatomically and or haemodynamically unstable pelvic ring disruptions treated with operative management and presents a retrospective analysis of injury pattern, surgical therapy and complications in surgically treated Tile B and Tile C disruptions.
Methods This study is a retrospective review of results of the operative management of pelvic fractures at the Alfred Hospital, Melbourne over the period of May 1997 to May 2001 (one to four years) using the Iowa Pelvic Score (Martin-American Academy Meeting 1999) to assess functional outcome. Initial screening resulted in 204 patients with pelvic disruptions via DRG coding. Of this 65 patients were managed operatively and only 34 patients were subquently included in the study. Exclusion criteria were; residual cognitive defect, hip or ace-tabular injury, spinal injury with neurological deficit, repeat trauma or ongoing litigation. The inital data gathered included; age, sex, type of accident, Tile classification, neurological injury, urogential injury, type of treatment, adequacy of treatment, post-operative complications, length of hospital and stay in rehabilitation. A follow-up survey was performed for each of these patients by telephone to obtain a post-operative functional outcome score. Thirty two of the 34 patient were able to complete the survey.
Results Thirty-four patients were included in the study with 29 (85%) males and five (14%) females. The modes of injury were as follows: five motor car occupants, 13 motorbike riders, three pedestrians struck by motorcar, three falls, three occupational and seven other. Twenty-seven were classified as Tile B and seven Tile C. These fractures were treated with the following; external fixation alone was used in four patients, external fixation followed by anterior plating was used for 18 patients, anterior plating and posterior ilio-sacral screws were used for nine patients, three patients received both anterior and posteior plate fixation. The mean number of operations to stabilize the disruptions was two. The major complication incurred by most of the patients was pin site infection. The mean length of hospital stay was 25 days and the mean length of rehabilitation stay was 35 days. Of the 32 patients interviewed all had function outcome scores greater than 70 (good). Most (n=13) of them returned to full time work. All reported cosmetic changes in their pelvis.
Conclusions We feel that this study provided good quality retrospective data for the demographics and surgical therapy used to stabilize pelvic ring disruptions that are unstable. These results were consistent with current belief that internal fixation of pelvic fractures produced good functional outcome.
The abstracts were prepared by Mr Jerzy Sikorski. Correspondence should be addressed to him at the Australian Orthopaedic Association, Ground Floor, William Bland Centre, 229 Macquarie Street, Sydney NSW 2000, Australia.
None of the authors have received any payment or consideration from any source for the conduct of this study.
