Application of early total care in treatment of unstable pelvic fractures

Abstract

Objective To evaluate the clinical effect of early total care (ETC) for treatment of unstable pelvic fractures. Methods This retrospective case series study included eighteen patients with unstable pelvic fractures treated surgically from May 2013 to May 2015. There were 11 male and 7 female patients, aged (45.1±13.1)years. Eleven patients were injured due to road traffic accidents and 7 due to fall from height. Tile B type pelvic fractures were seen in 8 patients and Tile C type in 10 patients. All patients were treated with ETC method and received open reduction and internal fixation within 24 to 48 hours after the primary treatment. Data were collected, such as operation time, intraoperative blood loss, hospital length of stay and perioperative complications. Majeed score and EuroQol 5 dimension (EQ-5D) were used for evaluation of clinical outcome and quality of life respectively. Excellent and good rate of operation was assessed using the Matta clinical evaluation standard. Results Three patients died and fifteen patients survived. Operation time was (120.1±22.2)minutes, amount of intraoperative blood loss was (355.9±56.4)ml, and hospitalization was (8.5±1.6)days. Incidence of perioperative complications was 56%, including 3 patients with acute respiratory distress syndrome, 1 pneumonia, 2 acute lung injury, 1 incisional wound infection, 2 multiple organ failure and 1 diffuse intravascular coagulation. All patients were followed up for (15.1±2.4)months (range, 12-21 months). Majeed score was decreased from preoperative (93.7±6.1)points to final follow-up of (74.1±9.2)points, and the EQ-5D index was decreased from preoperative 0.96±0.04 to final follow-up of 0.74±0.19 (both P<0.05). Excellent and good rate of operation was 80%. Conclusions ECT provides satisfactory short-term outcome for treatment of unstable pelvic fractures, but the incidence of complications is high. Doctors should choose reasonable treatment plan according to the surgical indications. Key words: Pelvis; Fracture fixation, internal; Postoperative complications