LONG-TERM OUTCOME OF PERCUTANEOUS TREATMENT OF UNSTABLE PELVIC FRACTURES

Abstract

Aim: The outcome of pelvic fractures are dependent on the anatomic reduction and stabilization of these fractures. Treatment of these fractures evolved recently and percutaneous treatment became the choice of treatment in most cases. The aim of this study is to evaluate the outcome of percutaneous treatment of unstable pelvic fractures.

Material and Methods: Twenty patients (11 female, 9 male) who had unstable pelvic fractures treated percutaneously between August 2004 and August 2006 formed the basis of study. Hospital charts, pre and postoperative PA, inlet and outlet pelvis X-rays, computed tomographies evaluated. Fractures are classified according to Young and Burgess and Injury severity scores(ISS) were calculated. SF-36 health related outcome scores, Majeed scores, Iowa Pelvic scores and Pelvic outcome scores (that also evaluates postoperative X-rays for residual anterior and posterior displacement) were calculated for the assesment of outcome.

Results: The mean age of the patients were 32(11–66) The minimum follow-up was 2 years with a mean of 33,3(24–48). Mean ISS was 31(16–50). Five patients have APC type 3, 3 patients have APC type 2, 3 patients have LC type 2, 4 patients have LC type 3, 4 patients have VS ve 2 patients have CM type injuries. Iliosacral screws are applied to all patients and for 11 patients additional anterior colon screw was applied. One anterior colon screw was removed because of an intraarticular placement and another removed for superficial infection. One iliosacral screw was revised for treatment of pseudoarthrosis. At the last follow-up meanSF-36 pain score was 82 +/−14,9 (normal for urban population: 81.0 ± 20.2) and mean functional SF-36 score was 80.5 +/− 11,8 (normal for urban population: 83.8 ± 20.0). Mean functional pelvic score was 93.3+/−8,7(19 excellent and one good clinical grade) and Iowa pelvic score was 86,2+/−2,8. Mean pelvic outcome score was 33,2+/−3,7 (maximum score is 40)

Conclusion: Percutaneous treatment of unstable pelvic fractures is the treatment of choice as if it avoids extensile approach, bleeding,wound problems and long lasting surgeries. Excellent outcomes can be achieved but since it is a technically challenging procedure good equipment and surgical experience is needed.