Nonoperative treatment of intermediate severity lateral compression type 1 pelvic ring injuries with minimally displaced complete sacral fracture.

Abstract

Controversy exists regarding optimum management of lateral compression type 1 (LC1) pelvic ring injuries (OTA type 61-B2.1), particularly in patients with complete sacral fractures. We hypothesized that nonoperative treatment would result in acceptable functional outcomes. Database review. Level I trauma center. We identified patients treated for LC1 fractures (n = 406) from 2007 to 2011 and analyzed a subset of LC1 injuries of "intermediate severity" characterized by complete sacral fracture with less than 1 cm initial displacement (n = 104). Fifty patients were contacted for functional outcome assessment at average follow-up of 33 months. Majeed pelvic score and physical component summary (PCS) score and mental component summary (MCS) score of 12-item Short-Form Health Survey version 2. Average Majeed pelvic score was 85.5, yielding 33 excellent, 9 good, 5 fair, and 3 poor outcomes. Mean PCS and MCS scores were 48.8 and 48.9, respectively (both confidence intervals include 50, the score for a healthy normative population). Patients with lower extremity injuries had a trend toward lower PCS and MCS and statistically significant lower mean Majeed scores (P = 0.01). Thirty-five of 37 patients without lower extremity injury had good or excellent categorical outcomes based on Majeed scores. No significant differences were observed regarding weight-bearing status, extent of anterior ring injury, or injury severity score. Radiographic follow-up was available for 36 of 50 patients. No fracture was displaced >1 cm. Acceptable functional outcomes can be expected after nonsurgical management of LC1 pelvic injuries with complete sacral fracture and less than 1 cm initial displacement. Therapeutic level IV.