Fracture of the pelvic ring: a retrospective review of 224 patients treated at a single institution

Abstract

Pelvic ring fracture presents with a wide spectrum of clinical status and fracture type that requires multimodal treatment strategy. We report our experience in the treatment of 224 pelvic ring fractures in terms of clinical and radiological findings, mode of treatment, surgical data, and functional outcome at final follow-up. The study subjects were 140 men and 84 women (mean age 58 years, range 8–94). Surgery was conducted in 63 patients, while 161 were treated conservatively. The average follow-up period was 7.1 years (range 1–15). AO-Orthopaedic Trauma Association classification of fracture type, Injury Severity score rating, Rommens and Hessmann’s ambulatory and pain assessment, and radiographic studies were conducted. Conservative treatment was provided in 161 (73%) patients, including simple bed rest with definitive external fixation, skeletal traction, and/or pelvic sling. Of these, 148 patients achieved excellent/good results, but the remaining 13 cases complained of severe pain at the sacroiliac joints caused by malunion or fibrous union of the joint. All 63 (27%) patients who were treated surgically, using most frequently a combination of anterior extraperitoneal and Pfannenstiel approaches, showed excellent/good clinical and radiographic results. Treatment of unstable pelvic ring fracture should be urgent and based on biomechanical and anatomic reconstructive strategy, paying utmost care to associated injuries. A combination of open stabilization of posterior sacroiliac area and anterior fixation of pubic rami and symphysis pubis is recommended for unstable anteroposterior compression, lateral compression, vertical instability, and unilateral or bilateral posterior injuries to the pelvic ring.