Determine the infection risk of nonoperative versus operative repair of extraperitoneal bladder ruptures in patients with pelvic ring injuries. Pelvic ring injuries with extraperitoneal bladder ruptures were identified from a prospective trauma registry at two level 1 trauma centers from 2014 to 2020. Patients, injuries, treatments, and complications were reviewed. Using Fisher's exact test with significance at P value < 0.05, associations between injury treatment and outcomes were determined. Of the 1127 patients with pelvic ring injuries, 68 (6%) had a concomitant extraperitoneal bladder rupture. All patients received IV antibiotics for an average of 2.5 days. A suprapubic catheter was placed in 4 patients. Bladder repairs were performed in 55 (81%) patients, 28 of those simultaneous with ORIF anterior pelvic ring. The other 27 bladder repair patients underwent initial ex-lap with bladder repair and on average had pelvic fixation 2.2 days later. Nonoperative management of bladder rupture with prolonged Foley catheterization was used in 13 patients. Improved fracture reduction was noted in the ORIF cohort compared to the closed reduction external fixation cohort (P = 0.04). There were 5 (7%) deep infections. Deep infection was associated with nonoperative management of bladder rupture (P = 0.003) and use of a suprapubic catheter (P = 0.02). Not repairing the bladder increased odds of infection 17-fold compared to repair (OR 16.9, 95% CI 1.75 – 164, P = 0.01). Operative repair of extraperitoneal bladder ruptures substantially decreases risk of infection in patients with pelvic ring injuries. ORIF of anterior pelvic ring does not increase risk of infection and results in better reductions compared to closed reduction. Suprapubic catheters should be avoided if possible due to increased infection risk later. Treatment algorithms for pelvic ring injuries with extraperitoneal bladder ruptures should recommend early bladder repair and emphasize anterior pelvic ORIF

The rate of arterial injury in trauma patients with pelvic ring fractures has been cited as high as 15%. Addressing this source of hemorrhage is essential in the management of these patients as mortality rates are reported as 50%. Percutaneous techniques to control arterial bleeding, such as embolization and REBOA, are being employed with increasing frequency due to their assumed lower morbidity and invasiveness than open exploration or cross clamping of the aorta. There are promising results with regards to the mortality benefits of angioembolization. However, there are concerns with regards to morbidity associated with embolization of the internal iliac vessels and its branches including surgical wound infection, gluteal muscle necrosis, nerve injury, bowel infarction, and thigh / buttock claudication. The primary aim of this study is to determine whether pelvic arterial embolization is associated with surgical site infection (SSI) in trauma patients undergoing pelvic ring fixation. This observational cohort study was conducted using US trauma registry data from the American College of Surgeons (ACS) National Trauma Database for the year of 2018. Patients over the age of 18 who were transported through emergency health services to an ACS Level 1 or 2 trauma hospital and sustained a pelvic ring fracture treated with surgical fixation were included. Patients who were transferred between facilities, presented to the emergency department with no signs of life, presented with isolated penetrating trauma, and pregnant patients were excluded from the study. The primary study outcome was surgical site infection. Multivariable logistic regression was performed to estimate treatment effects of angioembolization of pelvic vessels on surgical site infection, adjusting for known risk factors for infection. Study analysis included 6562 trauma patients, of which 508 (7.7%) of patients underwent pelvic angioembolization. Overall, 148 (2.2%) of patients had a surgical site infection, with a higher risk (7.1%) in patients undergoing angioembolization (unadjusted odds ratio (OR) 4.0; 95% CI 2.7, 6.0; p < 0 .0001). Controlling for potential confounding, including patient demographics, vitals on hospital arrival, open fracture, ISS, and select patient comorbidities, pelvic angioembolization was still significantly associated with increased odds for surgical site infection (adjusted OR 2.0; 95% CI 1.3, 3.2; p=0.003). This study demonstrates that trauma patients who undergo pelvic angioembolization and operative fixation of pelvic ring injuries have a higher surgical site infection risk. As the use of percutaneous hemorrhage control techniques increase, it is important to remain judicious in patient selection

Aims: Evaluation of: 1/ type and incidence of pelvic ring injuries, 2/ type and incidence of associated injuries, 3/ type of pelvic ring injuries pathomechanism, 4/ influence of pelvic ring injuries on trauma severity score, 5/ analysis of clinical long term results. Material and methods: Retrospective evaluation of 257 patients with pelvic ring injuries treated between 1989–2003 had been made. Mean patients age was: 65 y.o. (Range: 32–61 y.o.). Mean follow-up time: 57,5 months (range: 18–192 m.). All patients were treated no operatively: bed-rest, hamaque suspension, and skeletal traction. Analysis of pelvic injuries was made by Tiles classification. Evaluation of pelvic injuries pathomechanism was made by Young-Burgess classification. Clinical end results were evaluated by Iowa Pelvic Score. In polytraumatized patients trauma severity was evaluated by AIS and ISS. Results: Incidence of pelvic injury in hospitalized patients was 1,3%. In study group there were following pelvic injury types: type A – 14 %, type B – 77 % and type C – 9%. Pathomechanisms of pelvic injuries in study group were following: type LC – 61%, type APC – 30%, type VS – 2%, type CMI – 7%. Long term clinical results in Iowa pelvic Score were for pelvic ring injuries: type A – 92 p., type B – 86 p., type C – 67 p. Mean value of ISS index in patients with pelvic ring injuries was 23p, mean value of ISS index in patients without pelvic ring injuries was 19p. Conclusions: 1/ pelvic ring injuries in standard orthopedic and traumatic department are rare, 2/ pelvic ring injuries are frequent in polytraumatized patients, 3/ type C according to Tile’s classification is the most frequent type of pelvic ring injury, 4/ type LC according to Young-Burgess classification is the most frequent type of pelvic ring injury pathomechanism, 5/ incidence of pelvic ring injury in polytraumatized patient increases ISS index, 6/ long term clinical results suggested that most pelvic ring injuries can be successfully treated nonoperatively

Introduction: Pelvic ring injuries represent a complex injury pattern and sometimes have significant consequences. The aim of this retrospective study is to delineate the indications of surgical treatment with emphasis in the anatomic reconstruction. Materials and Methods: 85 patients with pelvic ring fracture with or without acetabular fracture reviewed retrospectively. The average patient age was 34 years. Operative treatment was provided to 26 patients. Six isolated acetabular fractures were treated by ORIF. Twenty pelvic ring fractures were treated, by anterior Ex-Fix in five cases, Ex-Fix plus sacroiliac screws in three, anterior reconstruction plate plus sacroiliac screws in two, anterior plate plus sacral bars in three. The remaining seven patients with an additional acetabular fracture treated with anterior plate for the pelvis and plates for the acetabulum. Results: All the acetabular fractures were anatomically reduced. All fractures consolidated and no patient has developed hip AVN or post-traumatic arthritis. Brooker’s grade III ossifications complicated two patients. Partial neurological deficit of sciatic nerve was seen in three cases of acetabular fractures that improved spontaneously. A case of vertical shearing sacral fracture through the foramina presented with lumbosacral plexus paresis that recovered near normal function in 6 months. Deep infection complicated a case that subsided at 2 weeks on antibiotics and serial surgical debridement. Conclusions: The strict application on rational criteria and an exquisite surgical technique caring of the soft tissues produce satisfactory outcome of these injuries. The above-described surgical treatment shortens the hospital stay and allows early physiotherapy to restore function

Introduction: Injuries to the bony pelvis are a significant group of injuries with often serious implications. The close proximity of the bony pelvis to vital organs, it’s involvement in weight bearing and ambulation, and the high energy mechanisms usually required to produce these injuries produces a variety of injury patterns, associated injuries and possible outcomes. Aims: To determine the long-term functional outcomes of displaced pelvic ring injuries treated surgically in the United Kingdom. Methods: All patients with pelvic ring fractures treated surgically were contacted by postal questionnaire. Outcomes were measured using the SF-36, as well as ad-hoc tools including return to work and sporting activities. Injuries were classified using the Young and Burgess (YB) classification system. Results: There was a response rate of 70% (145 of 209 patients). Average age at injury was 40 yrs (16–74 yrs). Average follow up was 5.3yrs (1–12 yrs). There were 45 Antero-Posterior Compression (APC) injuries, 51 Lateral Compression (LC) injuries and 49 Vertical Shear (VS) injuries. 69% of the LC injuries had returned to some form of employment, compared with 58% of the APC injuries and 51% of the VS. 39% of the LC injuries had returned to their pre-injury sporting activities, compared with 27% of the APC and 33% of the VS. The average Physical Functioning Score of the SF-36 outcome tool was 73.2 for the LC injuries, 61.7 for the APC injuries and 63.3 for the VS injuries (scale 0–100, 100 representing best status). These trends were mirrored in the other outcome domains of the SF-36 tool. Conclusions: These results illustrate the long-term morbidity associated with pelvic ring injuries and relationship with injury subtypes. LC injuries appeared to perform better than APC and VS injuries in all outcome measures utilized. These findings may aid in determining the prognosis and provision of services for patients with pelvic ring injuries

Aim of study: To evaluate infectious complications in patients operated for pelvic ring injury (level 1 trauma-centre). Method: Retrospective study of patients treated for pelvic ring injury in 5 years (July 1999 – June 2004), in whom wound infection was diagnosed clinically (purulent secretion) or by microbiological culture. Results: In the period 102 patients with pelvic ring injury as part of polytrauma were treated in trauma-centre. Thirteen patients died during few hours after admission without any surgical treatment of pelvis fracture and were excluded from the study group. Type A fracture of AO/ASIF classification was diagnosed in 18 (20 %), type B in 48 (54 %), type C in 23 patients (26 %). Forty three patients were operated (25 ORIF, 18 external fixation). Postoperative infection was diagnosed in 4 patients (9 % of all surgically treated) with mixed bacterial flora isolated in 3 patients and negative culture in 1 patient. In the same time period the frequency of infectious complications after the surgical treatment of musculoskeletal injuries was 1,3 % and mixed bacterial flora was detected in only 40 % of them. Conclusion: In patients surgically treated for pelvic ring injury the occurence of infectious complications is significantly higher than in patients surgically treated for other skeletal injury. The infections are frequently poly-microbial

We investigated whether lateral compression type I injuries of the pelvic ring are inheritably mechanically stable. Between January 2005 to January 2007 all consecutive admissions of a tertiary referral center for pelvic ring reconstruction with a LC I injury pattern were eligible for inclusion. Exclusion criteria were other patterns of pelvic ring injuries. All patients underwent radiological assessment including AP pelvis, inlet/outlet views and CT. Patient demographics, mechanism of injury, other associated injuries, ISS, length of hospitalisation, type of operation, mode of mobilization, preoperative and postoperative visual analogue score pain VAS and follow up until fracture union were prospectively documented. Mechanical stability of the pelvic ring was assessed in the operating theatre under general anaesthesia. Instability was defined as displacement > 2 cm of the anterior or posterior elements. The minimum follow up was 12 months. Of 210 patients admitted with pelvic fractures, 40 fulfilled the inclusion criteria (LC1 type). There were 23 female 17 male and with a mean age of 33.5 (range 18–68). The mean ISS was 10 (range 9–19). 23 patients (group 1) were found to have more than 2 cm rotational displacement during EUA and were stabilised with SI screws posteriorly and a combination of retro-pubic screws, external fixator or plating anteriorly. 17 patients (group 2) exhibited minimal displacement less than 5mm and were not stabilised. Rotational instability > 2cm was characterised by complete fracture of the sacrum posteriorly. Stabilisation of the pelvic ring in group I was associated with a significant reduction of the VAS within 72 hours from surgery, early ambulation and discharge from the hospital. This study supports the view that not all LCI fracture patterns are mechanically stable. Examination under anaesthesia of the pelvic ring can assist the clinician in the decision making progress

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

Aim: To investigate whether lateral compression type I injuries of the pelvic ring are inheritably mechanically stable. Patients and Methods: Between January 2005 to January 2007 all consecutive admissions of a tertiary referral center for pelvic ring reconstruction with a LC I injury pattern were eligible for inclusion. Exclusion criteria were other patterns of pelvic ring injuries. All patients underwent radiological assessment including AP pelvis, inlet/outlet views and CT. Patient demographics, mechanism of injury, other associated injuries, ISS, length of hospitalisation, type of operation, mode of mobilization, preoperative and postoperative visual analogue score pain VAS and follow up until fracture union were prospectively documented. Mechanical stability of the pelvic ring was assessed in the operating theatre under general anaesthesia. Instability was defined as displacement > 2 cm of the anterior or posterior elements. The minimum follow up was 12 months. Results: Out of 210 patients admitted with pelvic fractures, 40 fulfilled the inclusion criteria (LC1 type). There were 23 female 17 male and with a mean age of 33.5 (range 18–68). The mean ISS was 10 (range 9–19). 23 patients (group 1) were found to have more than 2 cm rotational displacement during EUA and were stabilised with SI screws posteriorly and a combination of retropubic screws, external fixator or plating anteriorly. 17 patients (group 2) exhibited minimal displacement less than 5mm and were not stabilised. Rotational instability > 2cm was characterised by complete fracture of the sacrum posteriorly. Stabilisation of the pelvic ring in group I was associated with a significant reduction of the VAS within 72 hours from surgery, early ambulation and discharge from the hospital. Conclusion: This study supports the view that not all LCI fracture patterns are mechanically stable. Examination under anaesthesia of the pelvic ring can assist the clinician in the decision making progress

Aims: To determine the incidence and pattern of pain in patients with displaced pelvic ring injuries treated surgically. To investigate the link between pain and neurological injury. Methods: All patients with pelvic ring fractures treated surgically were contacted by a postal questionnaire. Assessment was made from validated pain scores, pain maps, a Visual Analog Scale (VAS) and correlated with outcome scores including SF36 and Euroqol. Injuries were classified using the Young and Burgess (YB) classification. Results: There was a response rate of 85% (151 of 178 patients). Average age at injury was 40 yrs (16–74 yrs). Average follow up was 5.3yrs (1–12 yrs). 72% were male. There were 31% Antero-Posterior Compression (APC) injuries, 37% Lateral Compression (LC) injuries and 32% Vertical Shear (VS) injuries. 76% of all patients reported activity related pain; 70% of APC, 73% of LC and 86% of VS injuries (p=0.05, Chi-squared test). These results correlated directly with the pain domain of the Euroqol tool. There were however no statistically significant differences in the interference of pain with work (SF36) or the VAS between injury classes. There was a 15% prevalence of neurological injury in the cohort (9% of APC, 11% of LC and 27% of VS injuries; p=0.03 Chi-squared test). There were no statistically significant differences in the prevalence of moderate to severe pain (Euroqol) or the VAS between those with and without significant neurological injury. The presence of neurological injury significantly affected return to employment but not return to sports or social activities. Conclusions: These results illustrate the prevalence of significant morbidity in patients with surgically treated pelvic ring fractures. Presence of pain could be linked to injury category but a link with neurological injury was not obvious. This can help give prognostic information to patients suffering displaced pelvic ring injuries requiring surgical reconstruction

Traditionally, unstable anterior pelvic ring injuries have been stabilised with an external fixator or by internal fixation. Recently, a new percutaneous technique of placement of bilateral supraacetabular polyaxial screws and subcutaneous connecting bar to assemble an “internal fixator” has been described. We present the surgical technique and early clinical results of using this technique in twenty-five consecutive patients with a rotationally unstable pelvic ring injury and no diastasis of the symphysis pubis treated between April 2010 and December 2013. Additional posterior pelvic stabilisation with percutaneous iliosacral screws was used in 23 of these patients. The anterior device was routinely removed after three months. Radiological evidence of union of the anterior pelvic ring was seen in 24 of 25 patients at a minimum 6 month follow-up. Thirteen patients developed sensory deficits in the lateral femoral cutaneous nerve (five bilateral) and only one fully recovered. The anterior pelvic internal fixator is a reliable, safe and easy percutaneous technique for the treatment of anterior pelvic ring injuries, facilitating the reduction and stabilisation of rotational displacement. However, lateral femoral cutaneous nerve dysfunction is common. The technique is recommended in cases with bilateral or unilateral pubic rami fractures and no diastasis of the symphysis pubis

Objective. We reviewed clinical results with minimally invasive method and using a new developed plate for unstable pelvic ring fractures, especially vertically unstable sacral fractures. Materials & Methods. Between 2002 and 2010, 35 patients with vertically unstable sacral fractures were treated with minimally invasive method and using an M-Shaped transiliac plate which was developed by the author. This plate is anatomically designed for posterior pelvic ring, and achieved rigid fixation. Patients included 19 male and 16 female, with the mean age of 46.2 (range, 17∼79) years old. According to the AO classification, 23 patients had a C1 injury, 9 had a C2 fracture, and 3 patients sustained a C3 injury of the pelvic ring. Functional outcome was assessed using the Majeed's functional evaluation and radiography. Minimum follow-up was one year. Results. All patients were not fixed anterior of pelvic ring. The average of surgical time was 85 minutes (range: 45∼150), and intraoperative blood loss was 332.8 ml (range: 35∼1055). Postoperative functional results were excellent and good in 30 patients (85.7 %), and fair in four cases due to infection or sciatic nerve paralysis, and one case of poor was nonunion. Three patients complicated wound healing delayed, but there were no residual pain and re-displacement. Conclusion. Using an M-Shaped transiliac plate can be achieved significant outcome and rigid fixation with minimal invasion for vertically unstable sacral fractures

Background Non-weight bearing hip is a common problem in the elderly population after a minor fall. Magnetic reasonance imaging (MRI) is used to diagnose occult fractures in the hip and the pelvic ring in these individuals. The aim of this study is to find the relationship between the incidence of occult fractures in the hip and that in the pelvic ring following low velocity trauma in the elderly. Material and Methods Between January 2000 and February 2004, 106 elderly patients (mean age = 81.4 years; range = 67–101 years), underwent an MRI scan of the pelvis and hip to rule out fracture neck of femur. All of them presented with a non-weight bearing hip after a history of low velocity injury. All had standard radiographs of the pelvis and the hip which did not reveal a fracture of the femoral neck. However, eight patients had fracture of the pubic rami visible on plain radiographs. MRI scans were subsequently performed in all of them to rule out an occult fracture of the femoral neck. Results Out of the 106 patients, 17 (16%) had intracapsular neck of femur fracture, 26 (24.5%) had extracapsular neck of femur fracture, 26 (24.5%) had pubic rami fracture, 17 (16%) had sacral fractures, and 37 (34.9%) had no fractures. All the sacral fractures occurred in patients with pubic rami fractures. Further except in one patient where the pubic rami fracture and the sacral fracture were contralateral, the remaining 16 patients had ipsilateral pubic rami and sacral fractures. None of the patients with pelvic ring fracture had associated femoral neck fracture. Conclusion Inability to weight bear after a fall is a common presentation in the elderly population. Falls can lead to fracture neck of femur or a fracture of the pelvic ring but seldom both. We can also conclude that in an elderly patient with low velocity injury, if a pelvic ring fracture is detected in the plain radiograph there is no indication for further MRI to rule out femoral neck fracture. Further, the fracture in the anterior and posterior pelvic ring commonly involves the same side than the contralateral side, in the elderly after trivial trauma

Background: Treatment of patients with partially or totally unstable pelvic ring disruptions includes primary anterior stabilization with an external fixator and additional posterior internal fixation. Iliosacral screws placed percutaneously under fluoroscopy or navigation guided techniques are widely accepted today to address the posterior lesions. Definite surgery is usually performed on a semi-emergent basis, whereas a delay of more than seven days in definite fixation is accompanied by a high rate of pulmonary complications, malreduction and infections. Purpose: To compare the outcome of patients with type B and C pelvic ring disruptions treated with immediate definite posterior fixation (within 24 hours) as compared to those treated with early fixation (24–96 hours from arrival). Patients and Methods: The medical records of 44 patients with type B and C pelvic ring disruptions were reviewed retrospectively. All posterior lesions were treated with closed reduction and internal fixation with percutaneously placed posterior iliosacral screws. Patients were divided into two groups, based on the time of definite fracture fixation from admittance to the ER. Immediate treatment included patients treated within 24 hrs of arrival (Group A), early intervention was defined as definite fracture fixation between 24–96 hrs from the patient’s arrival (Group B). Post operative radiographs (Pelvis AP, inlet and outlet) were used to assess the quality of final fracture reduction. Patient records were screened for demographic data, injury severity score and early morbidity and mortality. Results: Forty-four patients were treated between the years 1999–2002 due to posterior pelvic ring fractures. 70.5% of the patients were male, the majority of patients (41/44) were injured during motor vehicle accidents, two patients sustained work-related crush injuries and one patient was injured during a suicide attempt. Fracture patterns were classified according to the Tile classification, there were 31 type B and 13 type C fractures. Thirty patients were treated within 24 hrs of admittance to the ER (group A), fourteen were treated between 24 and 96 hrs from arrival (Group B). ISS averaged 19.5 in group A as compared to 17.8 in group B (p=0.74). Overall complication rates were low. Malreduction was noted in one patient (group A), one patient in each group became infected, S1 foraminal penetration occurred in two patients (Group A). Two patients in group A died due to complications not related to the orthopedic intervention. No significant difference was found between the complication rates in both groups (p=0.34). Conclusions: Immediate definite fixation of posterior pelvic lesions can be safely performed with posterior iliosacral screws. Comfortable nursing and early mobilization can be achieved without compromising the quality of fracture reduction and minimizes post-operative complications

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

Aim. To evaluate the outcome and complications of pubic symphysis plating in the stabilisation of traumatic anterior pelvic ring injuries. Methods. All patients who underwent anterior pelvic ring stabilisation with a pubic symphysis plate in a tertiary referral pelvic and acetabular reconstruction unit were studied. Patients were followed up annually for five years with AP, inlet and outlet radiographs at each visit. The fracture classification, type of fixation (including additional posterior fixation), and incidence of metalwork failure were recorded. Results. In a series of 178 consecutive patients, 159 (89%) were studied for a mean of 41 months (range 3 months to 13 years). There were 121 males and 38 females, with a mean age of 38 years (9-80yrs). Symphysis pubic fixation was performed in 105 AO-OTA type B and 54 AO-OTA type C injuries using a Matta symphyseal plate in 92, a reconstruction plate in 65, or a DCP in two patients. Supplementary posterior pelvic fixation was performed in 103 patients. Six patients (3.8%) required revision for failure of fixation or symptomatic instability of the pubic symphysis. A further seven patients (4%) had metalwork removed for other reasons. Metalwork breakage occurred in 66 patients (42%). 64 of these 66 patients were asymptomatic and metalwork was left in situ. Conclusion. Plate fixation of the symphysis pubis is an effective method of stabilising anterior pelvic ring injuries with a low rate of complications. There is a high rate of late metalwork breakage, but this is often not clinically significant

High-energy pelvic ring fractures are associated with polytrauma where staged surgery is recommended. While temporary skeletal stabilisation is part of the acute management, definitive care is done in a later phase. The purpose of this study was to evaluate the safety and efficacy of acute pelvic ORIF by comparing its short term outcome with those who were stabilised late. A 45-month retrospective review of the prospective pelvic fracture database of a level one trauma centre was performed. All high-energy trauma patients who were potential candidates for minimally invasive internal fixation of the pelvic ring were included. Patients were categorised as acute ORIF (<24 hrs) or late ORIF (>24 hrs). Demographics, ISS, pelvic AIS, 24 hour pack cell transfusions, physiological parameters, time to operating theatre, angiography requirement, LOS and mortality were recorded. Data was presented as mean+/−SD or percentages. Statistical significance was determined at ∗p<0.05 based on univariate analysis. Forty-three patients met inclusion criteria, seventeen patients had acute definitive ORIF (5.5 hrs to OT) and twenty-six late definitive ORIF (5 days to OT). Acute and late ORIF patients had statistically not different demographics (age: 48+/−22 years vs 40+/− 14, gender: 82% vs 79% males), injury severity (ISS: 30+/−18 vs 24.5+/−13, pelvic AIS: 3.7+/− 1 vs 3.4+/− 1.1) and 24 hour transfusion (4.7+/−5 U vs 6.6+/−4 U). Initial shock parameters were significantly worse in the acute ORIF group (∗SBP 69.7+/−17 vs 108+/−21 mmHg, ∗BD -7.35+/−4 vs -4.9+/−1.5 mEq/L, ∗Lactate 6.67+/−7 vs 2.51+/−1.3 mmol/L). Angiography was used 18% (3/17) vs 21% (6/29) of the cases. All early ORIF patients survived and one (3%) of the late ORIF patients died. The trend in shorter hospital LOS was not significant in the early ORIF group (25+/− 24 vs 37+/− 32 days) while the ICU LOS was comparable (12/17 patients with 2.9+/−2.5 days vs 15/26 patients with 3.7+/−3.6 days). Minimally invasive acute ORIF of unstable pelvic ring fractures could be performed even in severely shocked polytrauma patients. The procedure did not lead to increased rates of transfusion, mortality, ICU LOS or overall LOS. Furthermore, all these parameters showed a trend towards benefit compared to a staged approach

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

Aim. Evaluate the outcome and complications of anterior pubic symphysis plating in the stabilisation of traumatic anterior pelvic ring injuries. Methods. All patients who underwent pubic symphysis plating in a tertiary referral unit were studied. Fracture classification, type of fixation, complications, and incidence of metalwork failure were recorded. Results. Out of 178 consecutive patients, 159 (89%) were studied for a mean of 41 months. There were 121 males and 38 females (mean age 38 years). Symphysis pubic fixation was performed in 105 AO-OTA type B and 54 type C injuries using a Matta symphyseal plate (n = 92), reconstruction plate (n = 65), or DCP (n = 2). Supplementary posterior pelvic fixation was performed in 103 patients. 6 patients required revision for failure of fixation or symptomatic instability of the pubic symphysis. A further 7 patients had metalwork removed for other reasons. Metalwork breakage occurred in 66 patients (42%), at a mean of 17 months. 64 of these 66 patients were asymptomatic and metalwork was left in situ. Conclusions. Plate fixation of the symphysis pubis is an effective method of stabilising anterior pelvic ring injuries with a low complication rate. There is a high rate of late metalwork breakage, but this is not clinically significant

Aim: We have reviewed the patients treated in our institution with vertical shear fractures of the pelvis and report on our treatment protocol and long term functional outcome. Methods: Between Jan 1993 and Jan 2002 patients with vertical shear fractures were identiþed. Data such as age, sex, aetiology, associated injuries, ISS, resuscitation requirements, transfusion requirements, ICU/HDU stay, treatment, urological injuries, systemic complications, neurological injury and mortality were recorded and analysed. Functional outcome assessment was performed using the following generic tools: Euro-qol 5D (EQ), SF36 v2 (Short form), SMFA, Majeed score and VAS. Results: Out of 380 pelvic ring injuries we identiþed 31 vertical shear fractures in 29 consecutive patients (4 female). The median ISS Score was 22. Motorcycle accidents were responsible for 27%. Injuries were identiþed in the chest (12 patients), abdomen (8 patients) and extremities (14 patients). Urethral injury was present in 9 patients. Ruptured viscus was identiþed in 3 cases. At presentation neurologic deþcit was present in 9 cases. Posterior ring was stabilised in 3(0–13) days. Systemic complications developed in 6 patients Ð ARDS in 4 patients and sepsis in 2 (6%). The mean follow up was 39 months. Functional outcome using the Majeed score revealed that 1/3 of the patients did fair. TheSF-36 v2 analysis, EQ 5-D revealed a moderate functional outcome. The SMFA and the visual analogue score also revealed similar outcomes. Conclusions: Prompt resuscitation and early temporarily stabilisation 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 ßoor trauma as seen in this series of patients. Younger individuals seem to have a relatively better outcome when compared to the older age group