Evaluate the outcome and complications of anterior pubic symphysis plating in the stabilisation of traumatic anterior pelvic ring injuries. 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.Aim
Methods
There is controversy regarding the optimum method of stabilising traumatic anterior pelvic ring injuries. This study aimed to evaluate the role of pubic symphysis plating. All patients who underwent pubic symphysis plating in a regional pelvic and acetabular unit were studied. Fracture classification, type of fixation, complications, and incidence of metalwork failure were recorded. Out of 178 consecutive patients, 159 (89%) were studied for a mean of 37.6 months. There were 121 males and 38 females (mean age 43 years). Symphysis pubic fixation was performed in 100 AO-OTA type B and 59 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 102 patients. 5 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 63 patients (40%). 62 of these 63 patients were asymptomatic and metalwork was left in situ.Methods
Results
In a prospective study of 205 consecutive patients undergoing surgical stabilisation of acute pelvic and/or acetabular fractures, the incidence of proximal deep vein thrombosis (DVT) was 9.2%, pulmonary embolism (PE) was 1.9% and fatal PE 0.5%. Use of a DVT prophylaxis protocol, using a low molecular weight heparin (LMWH), administered within 24 hours of injury or achieving haemodynamic stability, was associated with a significantly lower incidence of thromboembolism (p=0.036). Increased rates of thromboembolism were associated with longer delays to surgery (p=0.013), delays to mobilisation of the patient post-operatively (p=0.017), delay in starting chemoprophylaxis (p=0.039) and higher injury severity scores (p=0.042). Patient age, sex, Glasgow Coma Scale and fracture classification were not associated with the development of thromboembolic complications. One hundred and thirty four patients had a pre-operative venous Doppler, seven patients had a proximal DVT identified of which six patients had a preoperative inferior vena caval filter applied and underwent successful surgical fracture stabilisation. Five filters were unable to be removed postoperatively and the patients remain on lifelong warfarin. A DVT prophylaxis protocol using LMWH is reported that is safe and effective.
Only 10–15% of those thought clinically to have a fractured scaphoid are confirmed as having fractures on initial radiographs. A further 1–20% of those who had initially negative radiographs go on to have fractures confirmed on subsequent radiographs taken 10–14 days later. Fifty patients initially considered clinically to have scaphoid fractures were identified: 32 females and 18 males, with a mean age of 32 years, range 10–88 years, 68% were noted to have injured their dominant hand. Four patients, (8%), had scaphoid fractures identified on initial radiographs and only 1 patient, (2%), was found to have an occult scaphoid later. Three patients were found to have other bony injuries leaving 42 patients, (84%), having no fracture identified. Thirty-eight of this final group could be contacted and completed telephone questionnaires. The remaining 4 were lost to follow up. Patients were asked questions about employment, time off work, interference with other activities and general satisfaction with treatment. The mean time in plaster was 16 days, range 9–42 days. Eighteen of those in work, (47% of the total, 66.7% of the workers), had time off work. The mean length of time off work was 18.4 days, range 14–42 days. Sixteen of these received full “sick pay” for their time off. Personal hygiene was affected in 84%, housework in 37.5%, sports/hobbies for 55%, driving in 76% and social activities in 11.8%. Only 2 patients overall, suffered personal financial loss which amounted to less than one hundred pounds each. Only 3 people, (8%), expressed dissatisfaction with their management when directly questioned. All patients would have preferred an immediate diagnosis had this been possible. Alternative to this treatment including bone scanning and MRI are discussed.
