Radiological analysis, operative management and functional outcome of open book pelvic lesions: A 13-year cohort study

Abstract

We present the clinical and radiological outcome of a 13-year cohort study of 38 open book pelvic lesions. All patients were treated in one Level I Trauma centre. In the posterior pelvis, sacro-iliac diastasis was seen in 31 patients, sacral fracture in 7. In all patients with sacro-iliac diastasis, the pubic bone was inferiorly displaced on the primary ap pelvic overview on the side of injury. All but one patient was treated with open reduction and internal fixation of the symphysis pubis. Additional stabilization of the posterior pelvis was done in 9 patients. 32 patients were seen after a median follow up of 84 months. Majeed score and SF-36 questionnaire were used. Functional outcome was excellent with a mean Majeed score of 95.7. Comparing our data with the SF-36 score of the normal German population, the mean value of the ‘role-physical’ and the ‘physical function’ categories was significantly lower for patients treated with an open book lesion. There was a tendency towards a better outcome in open book lesions with sacral fracture. There was a tendency towards worse outcome for the patients with additional dorsal stabilization. Male impotence was the single most important lesion of neurological origin which persisted two years after open book lesion. Conclusion Functional outcome after surgical treatment of open book pelvic lesions is good. External rotation and accompanying inferior displacement of the ipsilateral hemipelvis may be a sign of partial lesion of the posterior sacroiliac complex. Identification of patients who need additional posterior stabilization remains difficult.