Emergency pelvic stabilization in patients with pelvic posttraumatic instability.

Abstract

Unstable pelvic ring disruptions have been associated with high rates of morbidity. Accurate reduction with fixation diminishes pain, permits early patient mobility, and allows the pelvic ring to improve functional outcome. This was a retrospective study, whereby 30 polytrauma hospitalized patients were included, with unstable pelvic lesions stabilized with an external fixator as a mean of temporary or definitive fixation. Data collected for these sample were: age, sex, cause of trauma, type of pelvic lesion, associated lesions (ISS score), pelvic stabilization methods, and functional outcome. There were 17 male subjects (57%) and 13 female subjects (43%), with a mean age of 42.5 years (range 18-62 years). According to Tile classification, the unstable pelvic ring lesions prevailed; 60 % of patients were type C while three patients with type C instability had associated acetabular fractures, and 40% had type B rotational instability. Stabilization was achieved using an external fixator in 16 patients; in 14 patients the anterior ring fixation was used with an external fixator combined with posterior stabilization using percutaneous sacroiliac screws. The pelvic stabilization using the external fixator was later replaced with plates and screws (ORIF) in four patients. Follow-up at one, three, six and 12 months postoperatively was based on the Majeed functional score and radiographic assessment. Eighteen patients (78%) had an excellent Majeed functional score, four patients had a good score, and only one patient had a fair functional outcome. Malunions were recorded in four patients with Tile C that were stabilized only by external fixation, and superficial pin track infection occurred in three patients. Within the studied group seven deaths have been recorded (23%) in patients with extremely severe associated injuries (ISS over 50), this being the decisive factor that determined the unfavourable evolution in six patients. The external fixation stabilizes the anterior pelvic ring lesions and it can be combined with the posterior stabilization using percutaneous sacro-iliac screws in case of associated lesions of the posterior ring. The external fixator is very useful especially in the acute phase, acquiring an acceptable reduction and an adequate stability in the partially unstable lesions (Tile B) and also reduces the pelvic volume and bleeding, being considered essential within the resuscitation protocols. The external fixator can be used as a permanent stabilization method when it guarantees a satisfying reduction.