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.
