TREATMENT OF PELVIC RING DISRUPTIONS WITH THE ILIZAROV FRAME. PRELIMINARY REPORT.

Abstract

The pelvic ring unstable disruptions are by itself life threatening and its stabilization is one of the priorities. On the other hand the surgical approach and internal fixation of this type of injuries represent a long and aggressive intervention, with high blood loss and complications. By these reasons a methodology that not only allows a precocious and less aggressive intervention with the possibility of stabilization of the posterior and anterior elements of the pelvic ring, and also the possibility to introduce postoperative corrections is indicated.

In January 1999 we introduce in our Unit the treatment of pelvic ring fractures and disruptions with the association of Ilizarov frame and minimal invasive internal fixation. It is our intention to present the preliminary protocol of treatment and its results.

Until 2002 we have treated 97 cases of pelvic ring disruptions. We have treated surgically 26 patients. From those, 10 cases were of open book and closed book injury type (2 pubic platting, 4 static external fixator and 4 dynamic Ilizarov frame) and 7 cases were of vertical shear injury type (4 pubic plating and sacro-iliac bar/ screw, 3 dynamic Ilizarov frame).

Results were evaluated with our own protocol. Infection rate compromised final results of the cases treated by ORIF (4:6) and reduction was poorer with the static external fixator (2:4). Treatment with Ilizarov frame revealed 5 good results and 2 fair results.

The authors conclude that even with a limited number of patients and follow-up, the use of the dynamic Ilizarov frame with a minimal invasive approach, showed to be a simple, fast and efficient method for the handling of serious fractures and disruptions of the pelvic ring, allowing a good stabilization of the anterior and posterior components, permitting the “fine tuning” in the postoperative period, without major complications.