VERTICAL SHEAR FRACTURES OF THE PELVIC RING: TREATMENT PROTOCOL AND LONG TERM FUNCTIONAL OUTCOME – THE ST JAMES’S UNIVERSITY HOSPITAL EXPERIENCE

Abstract

We have reviewed the patients with vertical shear fractures of the Pelvis and report on our treatment protocol and long-term functional outcome.

Methods: Between January 1993 and January 2002, out of 581 pelvic ring injuries treated in our unit, we identified 31 vertical shear fractures in 29 (4.9%) patients (4 female). Data such as age, sex, aetiology, associated injuries, ISS, resuscitation and transfusion requirements were recorded. ICU/HDU stay, surgical stabilization, urological injuries, systemic complications, neurological injury and mortality were recorded and analysed. Functional outcome was assessed using the following generic tools: EuroQol EQ-5D, SF36v2, SMFA, Majeed score and VAS.

Results: The mean age was 43.5 (16–71). The median ISS was 22 (12–32). Motorcycle accidents were responsible for 27%. Associated injuries included the chest (12 patients), abdomen (8 patients) and extremities (14 patients). Urethral injury was present in 9 and ruptured viscus was identified in 3 patients. Neurologic deficit was present in 9 cases. Posterior ring was stabilized in 3 (0 – 13) days. 6 patients developed systemic complications – ARDS in 4 (12%) patients, sepsis in 2 (6%). The mean follow up was 39 (12–101) months. Functional outcome using the Majeed score revealed that one-third of the patients were fair. SF-36 (physical and mental scores) and EQ 5-score revealed that one-third of the patients were fair. SF-36 (physical and mental scores) and EQ 5-score revealed that one-third of the patients were fair. SF-36 (physical and mental scores) and EQ 5- D revealed a moderate functional outcome. The SMFA and the visual analogue score also revealed similar outcomes.

Conclusion: Prompt resuscitation and early temporarily stabilization of the pelvic ring is essential. Sound reconstruction of the pelvic ring is not always associated with good results, probably due to the extensive pelvic floor trauma seen in this series of patients. Younger individuals seem to have a relatively better outcome when compared to the older age group.