Staged reconstruction of pelvic ring disruption: differences in morbidity, mortality, radiologic results, and functional outcomes between B1, B2/B3, and C-type lesions.

Abstract

To analyze injury pattern, surgical therapy, radiologic results, and functional outcome in unstable B-type and C-type pelvic ring fractures. Retrospective study. Level I University Trauma Center. Two-hundred-twenty-two consecutive patients, admitted during a nine-year period with unstable B-type (n = 100) and C-type (n = 122) pelvic ring injuries, of whom 122 (61.3 percent of surviving patients) were eligible for evaluation with a minimum follow-up of one year. Staged reconstruction dependent upon injury pattern. Emergency external compression of the pelvic ring in case of hemodynamic instability. Management of associated lesions. Secondary open reduction and internal fracture fixation. Assessment of perioperative and postoperative mortality and morbidity depending on fracture pattern. Fifty-five B-type and sixty-seven C-type lesions were evaluated clinically and radiologically an average of 21.6 months after trauma. Perioperative mortality was 5 percent in B-type and 15 percent in C-type fractures. External fixation was part of the definitive treatment in 52 percent of B-type and in 38 percent of C-type lesions. Planned secondary operative procedures were performed in 15 percent of B-type and in 26.2 percent of C-type fractures. Radiologic results were anatomic in 93.5 percent of B1, 75 percent of B2/B3, and 62.7 percent of C-type lesions. Functional results were excellent or good in 74 percent of the B1, 92 percent of the B2/B3, and in 71 percent of the C-type fractures. Unstable pelvic ring fractures require a staged approach. Mortality is higher in C-type than in B-type lesions. Functional outcome is worse in C-type than in B-type lesions. Within the B-type group, B1 lesions have a worse functional end result than B2/B3 fractures. These findings are not only related to the stability and symmetry of the pelvic ring, as seen in the radiologic picture, but also depend on the severity and amount of damage to the soft tissues around the pelvis.