Late fixation of vertically unstable type-C pelvic fractures: difficulties and surgical solutions

Abstract

Delayed surgical stabilization of unstable pelvic ring disruptions is expected to have difficulties in achieving reduction and fixation with possible higher complications. The aim of this study is to report the difficulties and to evaluate the results of late surgical stabilization of vertically unstable type-C pelvic injuries. This study included 16 patients with 20 vertically unstable pelvic fractures who presented 4 weeks or more after the initial trauma during a period of 5 years. Time since injury averaged 7.6 weeks. Age of the patients averaged 28 years. There were 12 unilateral and four bilateral injuries. Seven patients had neurologic injuries. Combined posterior and anterior pelvic ring stabilization was carried out in nine patients, while posterior pelvic ring fixation alone was done in seven. The mean postoperative follow up was 31 months. All fractures healed with average 14 weeks. Complications included transient L5 palsy, ilio-femoral DVT, and early metal failure. Fracture reduction was considered excellent in 69 %, good in 25 %, and fair in 6 %. Functional outcome according to Majeed score was excellent in 75 %, good in 19 %, and fair in 6 %. There was a high significant positive correlation between time of treatment and fracture reduction (p = 0.009) and a significant correlation between preoperative neurological co-morbidity and functional outcome (p = 0.015). A significant negative correlation was found between functional outcome and fracture type (p = 0.039). Surgical management of delayed vertically unstable pelvic fractures is recommended to achieve anatomical reduction and rigid fixation and to avoid long-term morbidity.