Operative treatment of unstable pelvic ring fractures

Objective To evaluate the operative treatment for patients with unstable pelvic ring fractures. Methods A retrospective study was done for the 83 patients with unstable pelvic ring fractures who had received operative treatment from January 2002 to January 2008 and complete follow-up. The duration from injury to operation averaged 12. 0 (0 to 51) days in this group. According to Tile classification, there were 35 cases of type B (B1: 17; B2: 11; B3: 7) and 48 type C (C1: 34; C2: 9; C3: 5). Sixty-six patients had associated injuries. Twenty-five cases were complicated with sacral fractures (Denis Ⅰ: 5; Denis Ⅱ: 16; Denis Ⅲ: 4), and 23 patients with acetabular fractures. Twelve hemodynamically unstable patients received resuscitation. Simple anterior ring fixation was applied in 17 patients, simple posterior ring fixation in 29 patients and combined anterior and posterior fixation in 37 patients. The functional outcome was evaluated using Majced and Harris scores. Results One patient died during the early postoperative period. The mean follow-up was 3.3 (1.0 to 7.1) years for the other 82 patients. At the time of final follow-up, the mean Majeed score was 87.5 (51 to 100). The clinical outcome was excellent in 55 patients, good in 22, fair in 4 and poor in 2. The overall good to excellent rate was 92. 7%. The mean Harris score was 91.1 (50 to 100) . The clinical outcome was excellent in 59 patients, good in 17, fair in 1 and poor in 5. The overall good to ex-cellent rate was 92.7%. Of the 17 cases with associated acetabular fractures that were operatively treated, 14 were graded as good and excellent. Of the 19 patients with associated lumbosacral plexus injury before oper-ation, 11 obtained full recovery, 5 partial recovery and 3 no recovery. Of the 10 cases with iatrogenic nerve injury, 9 obtained full recovery and 1 partial recovery with residual weakness of foot and ankle dorsiflexion.Implant failure occurred in 3 cases. Conclusions Good clinical results can be expected with operative treatment for unstable pelvic ring fractures. Severe lumbosacral plexus injury, implant failure and associated acetabular fracture are risk factors for an unsatisfactory clinical result. Key words: Pelvis;  Fractures;  Fracture fixation;  Treatment outcome