Outcome of operatively treated type-C injuries of the pelvic ring

Abstract

Background Internal fixation has become the preferred treatment for type-C pelvic ring injuries, but controversies persist regarding surgical approach and surgical technique.Patients We evaluated 101 consecutive patients with type C1-C3 pelvic ring injuries who had been treated with standardized reduction and internal fixation techniques.Results Our findings suggest a correlation between excellent reduction followed by sufficient fixation of the pelvic ring and functional outcome. Unsatisfactory reduction (displacement > 5 mm), failure of fixation, loss of reduction and a permanent lumbosacral plexus injury were the commonest reasons for an unsatisfactory functional result. All 40 patients with an associated lumbosacral plexus injury showed at least some evidence of neurological recovery. 14 underwent complete neurologic recovery. 8 had only sensory deficits and the remaining 18 also had motor deficits at the final followup. Complications were rare, but some of them were severe: loss of reduction in 8%, malunion in 10%, deep wound infection in 2%, and a lesion of the L5 nerve root in 1%.Interpretation Our results suggest that special attention should be paid to preoperative planning, reduction of the fracture, decompression of the nerve roots, and fixation of the most severe sacral fractures. Our results seem to favor internal fixation of displaced (> 10 mm) and unstable rami fractures and symphyseal disruptions in conjunction with posterior fixation, to achieve better stability of the whole pelvic ring.

Minimally invasive stabilisation of posterior pelvic-ring instabilities with a transiliac locked compression plate

“…This is in line with the functional outcome reported after SI screw fixation. Lindahl and Hirvensalo reported 83% of patients having excellent or good results following SI screw fixation [13], and Cole et al reported 70.6% of patients with none or only minor functional deficits [5]. As reported by Lindahl and Hirvensalo, post-traumatic pain appeared to be the main driver for the majority of fair results, which accords with our patient population [13].…”

“…Lindahl and Hirvensalo reported excellent/good radiological results in 90% of patients managed with SI screw fixation [13]. Seventy-two percent of our patients returned to their previous work without restrictions, 14.3% were handicapped at work and 14.3% had not returned to work upon follow-up.…”

“…In contrast, SI screw positioning is demanding, and screw malpositioning may be associated with neurovascular injuries and loss of reduction in up to 7.7% of patients [7]. Lindahl and Hirvensalo reported loss of reduction in 6% and screw malpositioning in 2% of patients [13]. According to Routt et al,8.8% of sacral screw fixations failed [22].…”

Displaced spinopelvic dissociation with sacral cauda equina syndrome: outcome of surgical decompression with a preliminary management algorithm

“…Similarly, Denis et al [2] declared that the residual neurological deficit is critical factor affecting the functional outcome. Lindahl and Hirvensalo [19] documented the permanent neurological injury as a strong prognostic factor. Roy-Camille type III injuries had significantly worse outcome in this series.…”

Does Surgical Stabilization of Lateral Compression-type Pelvic Ring Fractures Decrease Patients’ Pain, Reduce Narcotic Use, and Improve Mobilization?

“…LC1 represents a broad spectrum of injury, including within the same category minimal ''buckle'' impaction fractures of the anterior sacrum to comminuted sacral fractures that extend to and through the posterior cortex [14]. There is general agreement that fractures displaced more than 1 cm benefit from surgical stabilization, but it is unclear if LC1 and LC2 fractures that are minimally displaced on radiographs obtained shortly after injury benefit from surgical intervention [7,16,20].…”