Abstract
Purpose: To analyze the long-term functional outcome of vertical shear fractures to other forms of severe pelvic injuries: APC-III, LC-III, and complex acetabular fractures.
Methods: We identified 31 VS fractures in 29 consecutive patients. A retrospective chart analysis was performed and analyzed in a control group comprising of 98 patients matched for age and sex: 34 APCIII, 32 LC-III and 32 complex acetabular fractures. Functional outcome was assessed in all patients using EuroQol EQ-5D, SF36, VAS, SMFA, Majeed score. Merle d Aubigne and Postel scores (Matta 1986) and radiologic degenerative hip scores (Matta 1994) were used to assess patients with acetabular fractures.
Results: Mean age of patients was 43.5 yrs, median ISS-22. In VS group 35% returned to their previous jobs (49% in control group), 30% had changed jobs (30%) and 25% (14%) had retired from regular work. In acetabular group 10 patients had neurologic injury and 3 patients had total hip arthroplasties at 29,40,51months. The clinical outcome (Matta scores) of patients in the acetabular group was:5 excellent (3 THA), 4 good, 13 fair,10 poor. The radiologic Matta score for acetabular group was: 4 excellent, 8 good, 14 fair, 3 poor. Mean EQ-5D description scores were 0.43, 0.63, 0.69, 0.49 and mean valuation scores were 46.1, 62.3, 78, and 51.4 for the VS, LCIII, APIII, and acetabular groups respectively. SF 36 physical health scores were 44.4, 62.5, 78.3, 54,2 and mental health score of 26.2, 68, 76.5 and 56.3 for VS, LCIII, APIII, and acetabular groups. SMFA dysfunction index was 63.3, 44.6, 38.3, 54.1 and the bother index was 60.5, 49, 34.2 and 57.2. There was a significant difference in EQ-5D score, SMFA, SF36 scores indicating poor outcome in the VS group compared to AP-III, LCIII group. There was no significant functional difference between the VS and acetabular group.
Conclusion: VS fractures represent the spectrum of high-energy pelvic disruption. Functional outcome is significantly better in patients with APC III, LC III fractures when compared to VS and complex acetabular fractures reflecting the severity of injury. Secondary osteoarthritis, neurologic injuries appear to contribute to the poor outcome of acetabular fractures. Sound reconstruction of pelvic ring is not always associated with good results probably due to extensive pelvic floor trauma as seen in this series of patients. Younger individuals seem to have a relatively better outcome when compared to the older age group.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
