Abstract
Aim: To review treatment, results and complications of pelvic ring injuries.
Materials & Methods: We reviewed 39 pelvic ring injuries, mean age 37 years, referred to a tertiary unit, with mean follow up 19 months (6 to 60). Data regarding type of fracture, associated injuries, treatment, injury surgery interval, complications and outcome was documented.
Results: Vehicular accidents in 21 were the commonest mechanism of injury and 30 had vertical shear fractures. There were 4 associated head injuries, 5 chest, 4 maxillo-facial, 4 perineal/ vaginal tears, 7 urological, 1 anorectal, 2 each of abdominal and ophthalmic, and 1 each of vascular, spine and brachial plexus injuries. Also there were 15 skeletal fractures, 12 soft tissue injuries and 11 associated acetabular fractures of which 8 needed fixation, and 17 had lumbosacral plexus injuries. 6 compound pelvic fractures were treated with debridement, fixation and early life saving bowel diversion. 19 patients had anterior external fixators, 9 were applied elsewhere for resuscitation.
Complications: There were 10 systemic complications, 4 ARDS, 2 wound infections and 1 colovesical fistula, 1 infected pubic plate, and 3 late inguinal hernias. 8 patients had pin track infections, and 5 iatrogenic problems including 2 nerve lesions, 2 vascular injuries and 1 bladder rupture, none of which left any residual problem.
Results: 20 patients had no pain, 31 were fully mobile without aids, and 22 had returned to original level of activity. 6 complained of sexual dysfunction, and 1 had double incontinence. 6 patients were on disability allowance, and 10 had full recovery of lumbosacral plexus injury.
Conclusion: Severe associated injuries and soft tissue trauma significantly affect outcome and complications, inspite of sound bony fixation and healing, and multi-disciplinary management is obligatory. Posterior ring lesions were often underestimated, and anterior external fixation alone can make them worse. Early colostomy is lifesaving in compound pelvic fractures. Early involvement of a specialist surgeon is desirable for optimal outcome, which can be achieved in most patients.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
