DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20220605

The early definitive internal fixation of Complex Pelvic Fracture and its outcome: our experience in level 1 trauma care centre.

Nitin Kimmatkar, Kantharaju H.

Abstract


Background: Complex pelvic fractures have high mortality and morbidity hence required urgent resuscitation, haemodynamic stabilization and fracture fixation. Keeping in mind the various schools of thought regarding definitive management, there is need to study the outcomes of complex pelvic fractures after internal fixation surgery.

Methods: Twenty patients with complex pelvic fractures treated with internal fixation surgery in between 1st June 2018-31st December 2019 with at least 12 months follow-up were included. Clinical and functional outcome of these patients was studied and evaluated using Majeed and Hannover scoring systems.

Results: Of 20 patients, 19 had closed while 1 had open pelvic fracture while 11 had tile type B and 9 had tile type C fracture. After 12 months of follow up, 72% patients of tile B fractures and 55.6% in tile C had excellent Majeed score with rest having good score. Hannover score was very good in 36.4% tile B cases and 22.2% tile C cases and good in 63.6% tile B cases and 77.8% tile C cases. Type of fracture (type B or type C) had a statistically significant co-relation with chronic pain (p=0.016). It was also found that urogenital injury and sexual dysfunction (p=0.007) had a significant co-relation.

Conclusions: Early definitive internal fixation in patients with complex pelvic fracture had very good clinical and functional outcome. Most common associated injuries in complex pelvic fractures are urogenital injuries due to close proximity. In the outcomes chronic pain and sexual dysfunction are major issues. The sexual dysfunction patients usually associated fracture of pubic rami or pubic diastasis.


Keywords


Complex pelvic fracture, Functional outcome, Complications, Majeed score, Hannover score

Full Text:

PDF

References


Ismail HD, Lubis MF, Djaja YP. The Outcome of Complex Pelvic Fracture after Internal Fixation Surgery. Malays Orthop J. 2016;10(1):16-21.

Ghosh S, Aggarwal S, Kumar V, Patel S, Kumar P. Epidemiology of pelvic fractures in adults: Our experience at a tertiary hospital. Chinese journal of traumatology. 2019 Jun 1;22(3):138-41.

Coccolini F, Stahel PF, Montori G, Biffl W, Horer TM, Catena F et al. Pelvic trauma: WSES classification and guidelines. World J Emergency Surg. 2017;12.1:1-18.

Schmal H, Markmiller M, Mehlhorn AT, Sudkamp NP. Epidemiology and outcome of complex pelvic injury. Acta Orthop Belg. 2005;71(1):41-7.

O'Sullivan RE, White TO, Keating JF. Major pelvic fractures: identification of patients at high risk. J Bone Joint Surg. 2005;87-B(4):530-3.

Incagnoli P, Puidupin A, Ausset S, Beregi JP, Bessereau J, Bobbia X et al. Early management of severe pelvic injury (first 24 hours). Anaesth Critical Care Pain Med. 2019;38(2):199-207.

Tile M. Acute Pelvic Fractures: II. Principles of Management. J Am Acad Orthop Surg. 1996;4(3):152s61.

Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg. 1989;71-B(2):304-6.

Dienstknecht T. The long-term clinical outcome after pelvic ring injuries. Bone Joint J. 2013;95(4):548-53.

Hak DJ, Smith WR, Suzuki T. Management of haemorrhage in life-threatening pelvic fracture. J Am Acad Orthop Surg. 2009;17(7):447-57.

Grimm MR, Vrahas MS, Thomas KA. Pressure-volume characteristics of the intact and disrupted pelvic retroperitoneum. J Trauma Acute Care Surg. 1998;44(3):454-9.

McDonald C, Firoozabadi R, Routt ML Jr, Kleweno C. Complications Associated with Pelvic External Fixation. Orthopedics. 2017;40(6):e959-63.

Lindahl J, Hirvensalo E, Böstman O, Santavirta S. Failure of reduction with an external fixator in the management of pelvic ring injuries: long-term evaluation of 110 patients. J Bone Joint Surg Brit Vol. 1999;81(6):955-62.

Halawi MJ. Pelvic ring injuries: Surgical management and long-term outcomes. J Clin Orthop Trauma. 2016;7(1):1-6.

Mardanpour K, Rahbar M. The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation. J Inj Violence Res. 2013;5(2):77-83.

Vallier HA, Cureton BA, Schubeck D. Pelvic ring injury is associated with sexual dysfunction in women. J Orthop Trauma. 2012;26(5):308-13.

Harwood PJ, Grotz M, Eardley I, Giannoudis PV. Erectile dysfunction after fracture of the pelvis. J Bone Joint Surg Bri Vol. 2005;87(3):281-90.

Metze M, Tiemann AH, Josten C. Male sexual dysfunction after pelvic fracture. J Trauma Acute Care Surg. 2007;63(2):394-01.

Shenfeld OZ. The incidence and causes of erectile dysfunction after pelvic fractures associated with posterior urethral disruption. J Urol. 2003;169(6):2173-6.

Kabak S, Halici M, Tuncel M, Avsarogullari L, Baktir A, Basturk M. Functional outcome of open reduction and internal fixation for completely unstable pelvic ring fractures (type C): a report of 40 cases. J Orthop Trauma. 2003;17(8):555-62.

Gerbershagen, Jürgen H. Chronic pain and disability after pelvic and acetabular fractures-assessment with the Mainz Pain Staging System. J Trauma Acute Care Surg. 2010;69(1):128-36.

Ramesh SK, Veerappa LA. Outcome analysis of pelvic ring fractures. Indian J Orthop. 2010;44:79-83.