Nonunion and Delayed Union of Fractures of the Pelvis

Treatment and Outcomes of Pelvic Malunions and Nonunions: A Systematic Review

“…The level of evidence of these studies was IV (retrospective/prospective uncontrolled case series [12,16,25,39,42,43,47,51,59,67] or case reports [1, 4, 6, 11, 17-19, 31, 32, 40, 46, 50, 61, 68, 69]). Four hundred thirtyseven patients were included for the final analysis (Table 1).…”

“…It was recorded as anterior, posterior, or simultaneously at both areas, nonradicular, activity-related, or disabling at various levels (from restricting pain at the extremes of the range of motion of the hips [4], sitting discomfort [39,42,47,51,69], dyspareunia, and sexual problems of mechanical origin [1,19,25,42,59] to bed confinement for patients with continuous debilitating pain [18,25,42,43,47,51]). Nonunions of the anterior elements could be pain-free [4,31,50] in contrast to those of the posterior elements in which they were mostly symptomatic [39,42,51]. Pain was attributed to the nonunion site, the produced pelvic instability, the deformity, and the altered mechanics in patients with malunion, or to a combination of all of these.…”

Symphysiodesis with a new compression plate

“…Irrespective of the method of fixation of the symphysis, long-lasting stability cannot be expected as the load on the symphysis causes movements, which will lead to a loosening of an implant (Sharp 1973 Pennal & Massiah (1980) state that "contoured A 0 DCP plates adequately control the symphysis and can be supplemented as necessary with a n external fixator and bone-grafting techniques". It seems probable that the eficacy of the internal fixation varies according to the severity of the pelvic injury, i.e.…”

Two-stage surgical procedure for treating pelvic malunions

“…Anatomical restoration of the pelvic ring has been correlated with better clinical results [12]. Similarly, delayed surgical treatment of pelvic malunion or nonunion aiming at restoring normal anatomy of the pelvis is worthwhile and improves quality of life [5,8,11,15] in terms of sacroiliac pain, limping due to leg length difference, sitting discomfort, and some non-neurological uro-sexual problems directly related to the pelvic deformity.…”

“…Though specific and anecdotal cases have been successfully treated with one-stage intervention [4], all late anterior and posterior reconstruction of the pelvic ring reported in the literature required major surgery with threestage interventions, including prone-supine-prone or supine-prone-supine procedures [5,8,10,11,15]. However, operative duration and consequently operative morbidity could be reduced by limiting these surgical techniques to a prone-supine two-stage-only procedure.…”