Abstract
BackgroundThis study aimed to share our experience of anterior ring fixation failure for unstable pelvic fractures and propose corresponding treatment strategies.MaterialsFrom January 2009 to December 2018, 93 charts of patients with pelvic fractures were retrospectively reviewed. Patients with failure of the anterior ring internal fixation within 3 months after initial surgery were analyzed. Quality of reduction was evaluated using the Majeed scoring system. Patients aging ≥ 18 years, with unstable pelvic fractures, Tile classification type B and type C pelvic fractures, combined injury of other organs that did not affect the operation and without important neurovascular damage were included. The exclusion criteria included: (1) pathological fracture, or combined with pelvic bone tumor or severe osteoporosis; (2) femoral fracture and thoracolumbar fracture; (3) open pelvic fracture; (4) Morel-Lavallée injury; (5) complicated acetabular fracture. The quality of the reduction of the anterior pelvic ring injury was evaluated on the x-ray film using the Majeed scoring system.ResultsAccording to the Tile classification of fracture, there were 23 cases of type B1, 17 cases of type B2, 11 cases of type B3, 28 cases of type C1, 6 cases of type C2, and 8 cases of type C3. The duration from injury to pelvic internal fixation ranged from 5 to 28 days. Seven out of 93 patients experienced failure of internal fixation of the anterior pelvic ring within 3 months, including 2 patients fixed with an external fixator and 5 patients fixed with a plate. Five patients undergoing revision surgery were followed up for 6–36 months with an average of 18 months. According to Majeed’s score at the last follow-up in the 5 patients undergoing revision surgery, there were 2 cases of excellent, 2 cases of good, 1 case of fair. The excellent and good rate reached 80%.ConclusionThe treatment of complicated unstable pelvic fractures requires performing internal fixation surgery within 2 weeks. It is necessary to make a preoperative plan and stabilize the posterior ring first, avoiding a single steel plate crossing the pubic symphysis.
Highlights
This study aimed to share our experience of anterior ring fixation failure for unstable pelvic fractures and propose corresponding treatment strategies.Materials: From January 2009 to December 2018, 93 charts of patients with pelvic fractures were retrospectively reviewed
Seven out of 93 patients experienced failure of internal fixation of the anterior pelvic ring within 3 months, including 2 patients fixed with an external fixator and 5 patients fixed with a plate
Unstable pelvic fractures are often caused by high-energy force, such as road traffic accidents, falls from height, and localized crush injuries [3], and may result in uncontrolled hemorrhage leading to a high rate of morbidity [4]
Summary
This study aimed to share our experience of anterior ring fixation failure for unstable pelvic fractures and propose corresponding treatment strategies.Materials: From January 2009 to December 2018, 93 charts of patients with pelvic fractures were retrospectively reviewed. Patients aging ≥ 18 years, with unstable pelvic fractures, Tile classification type B and type C pelvic fractures, combined injury of other organs that did not affect the operation and without important neurovascular damage were included. The quality of the reduction of the anterior pelvic ring injury was evaluated on the x-ray film using the Majeed scoring system. Surgical intervention may be isolated posterior or combined posterior and anterior surgical fixation using screws and plates to achieve anatomical reduction and natural healing of the unstable pelvic fractures [10, 11]. Due to the long learning curve of pelvic fracture surgery, some patients experienced internal fixation failure [14, 15] and secondary fracture displacement [16] after the initial surgery. Limited by the equipment and technology of the primary hospital, in case of the difficult reduction or massive perioperative bleeding, the surgeon may rush to complete the fixation step, which further increases the probability of failure of the internal fixation after the operation [17]
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