Surgical management of pelvic ring injuries: a study of twelve cases
Keywords:Pelvic ring injuries, Classification, Fixation methods, Sacral fractures
The bony pelvic ring is constituted of the sacrum and bilateral innominate bones and stabilized by the sacroiliac, sacrospinous and sacro tuberous ligaments. Secondary stabilization is provided by the iliolumbar ligaments. Injury to the posterior ring structures brings more severe clinical instabilities. Assessment of mechanisms and mode of injuries is necessary for management of pelvic injury. Twelve patients were involved in this study of different kinds of injuries by classification and methods of treatment four patients were treated by anterior fixation. Three by posterior and three by anterior as well as posterior. One was by conservative means. Anterior includes symphysis plating, posterior includes intrapelvic plates as well as sacroiliac percutaneous screw fixation. Combined includes posterior plating and sacroiliac screw and external fixator anteriorly. All patients showed good results in terms of stability, union of fracture, relief of pain and movements. Two patients had some residual neurological deficit as foot drop. Pelvic ring injuries need a specialized approach for management and outcomes. Application of appropriate classification for management plays a significant role in outcomes.
Tile M. Acute pelvic fractures I, Causation and classification. J Am Acad Orthop Surg. 1996;4:143-51
Alton TB, Gee AO. Classifications in brief: Young and Burgess classification of pelvic ring injuries. Clin Orthop Relat Res. 2014;472:2338-42.
Burgess AR, Eastridge BJ, Young JW. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990;30:848-56.
Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988;227:67-81.
Dujardin FH. Long-term functional prognosis of posterior injuries in high-energy pelvic disruption. J Orthop Trauma. 1998;12(8):592-3.
Durrant JJ, Ramasamy A, Salmon MS. Pelvic fracture-related urethral and bladder injury. J Roy Army Med Corps. 2013;159:32-9.
Gibbons KJ, Soloniuk DS, Razack N. Neurological injury and patterns of sacral fractions ures. J Neurosurg. 1990;72:889-93.
Cocolini F, Stahel FP, Mintori G, Bifi W, Honor MT, Catena F, et al. Pelvic trauma: WSES classification and guidelines. World J Emergency Surg. 2017;12:5.
Gray A, Chandler H, Sabri O. Pelvic ring injuries: classification and treatment: pelvic and acetabular trauma. 2018;32(2):80-90.
Gansslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H. Epidemiology of pelvic ring injuries. Injury. 1999;27(1):13-20.