Operative treatment of unstable pelvic posterior ring lesion

Abstract

Objective To explore selection of appropriate internal fixation methods for unstable pelvic posterior ring lesions in order to provide the basis for clinical internal fixation. Methods The study involved 53 patients with unstable pelvic posterior ring lesions treated with reconstruction plate and sacroiliac screws from June 2003 to March 2008. There were 39 males and 14 females, at age range of 10-69 years (mean 39.5 years). Injury causes included traffic accidents in 36 patients, fall from height in 12 and crush in five. As for the state of injury to the pelvic posterior ring, seven patients had vertical fracture of the ilium and 27 had unstable sacral fractures (14 with Ⅰ section sacral fracture, 11 with Ⅱ section sacral fracture and 2 with Ⅲ section sacral fracture). Of 19 patients with unstable sacroiliac dislo-cations, 10 patients were accompanied with fracture of the ala sacrabs, seven with ala iliac fracture and two ear-shaped joint and ligament lesions. The period from injury to operation was 3-28 days (mean 6.7 days). Of all patients, seven patients were treated with reconstruction plate via anterior approch, 26 with percutaneous reconstruction plate via posterior approach and 20 with percutaneous sacroiliac screws.Results All patients were followed up for 12-36 months (mean 17.2 months), which showed no inci-sional infection, nerve injuries, loosening or breakage of the screw. All patients attained bone union, with equal lower limbs. According to Matta criterion for fracture reduction, the results were excellent in 19 pa-tients, good in 27 and fair in seven, with excellence rate of 87%. According to the Majeed functional scoring, the results were excellent in 19 patients, good in 27 and fair in seven, with excellence rate of 87%. The hypoesthesia at saddle area or dysuria in five patients were alleviated but two patients with sac-riplex injury resulted in perineal numbness and footdrop. Conclusions Surgical reconstruction of the pelvic posterior ring can attain sound functional recovery. For unstable pelvic posterior ring lesions, ap-propriate internal fixation methods may be selected according to fracture types, serviceable range of inter-nal fixations, experiences of the operator and equipment support. Key words: Pelvis; Fracture fixation,internal; Joint instability; Sacroiliac joint