Results of Surgical Treatment of Pelvic Fractures at Department of Traumatology Tomas Bata Regional Hospital, Zlín

Czech version

Authors: M. Lisý; P. Kacr; M. Guřan
Authors‘ workplace: Department of Traumatology, Tomas Bata Regional Hospital, Zlín, Czech Republic ; Traumatologické oddělení, Krajská nemocnice Tomáše Bati, a. s. Zlín
Published in: Úraz chir. 19., 2011, č.1

Overview

PURPOSE OF THE STUDY:
The authors present a group of patients treated by internal fixation for pelvic fractures in the years 2005–2009 and they evaluate clinical outcomes.

MATERIAL AND METHODS:
In the years 2005 –2009, 46 patients (12 women, 34 men, average age 44 years, range 18 to 82 years) underwent in-ternal fixation of pelvic fracture at the aut-hors´department.

The clinical outcomes were based on the Majeed scoring system.

RESULTS:

In 82 % of the patients, pelvic fractu-res were due to a high-energy trauma caused by traffic accidents in 46 %, by falls from heights in 30 % and by other causes in 6 %. Low-energy sport trauma accounted for 11 % (falls from a bicycle). Type A of pelvic fracture was in 4 patients (8.7 %), type A of isolated acetabular fracture was i 2 patients (4.3 %), type B of pelvic fracture in 18 patients (39.1 %), of isolated acetabular fracture in 3 patients (6.5 %), type C of pelvic fracture in 19 patients (41.3 %).

Associeted injuries were present just in type B and C pelvic fracture. Primary neurological deficit was in 2 patients (4.3 %) with type B fracture and in 6 patient (13 %) with type C. Urogenital injury was presents in 2 patients (4.3 %) with type B fracture a in 3 patients (6.5 %) with type C fracture.

The most used fixation of anterior pelvic segment was plate (in 61.7 %). Sacroiliacal lag screw was the most used fixation of posterior pelvic segment (in 8.3 %).

Intra-operative complications were recorded in 4.3 %, early post-operative ones in 15.2 %, and late ones in 6.5 %. Infectious complication was in 6.5 %.

All patient with type A pelvic fracture had excellent outcomes. Excellent and good clinical outcomes were achieved in 94 % and 66 % of the patient with type B and C pelvic fracture.

DISCUSSION:
The high apperence of primary neurological and urogenital injuries in type B and C fracture was supposing. The higher percent of the neurological complications in type C fractures is expected due to severe injury mecha-nism and laesion of posterior pelvic segment. The severe total patient status, long time staying at anesthesiologic-resustitation department, and soft tissue contusion are reason for higher number of infectious complications.

CONCLUSION:
The pelvic fractures are very problematic part of traumatology. The pelvic ring injuries are mostly like associated injuries or polytrauma. For this reason the complex multidisciplinary cooperation is necessary. The urgent primary pelvic stabilization, right timing of definitive internal fixation and anatomic reposition can reduce the complications and permanent disability.

Key words:
pelvic fracture, associated injuries, surgical treatment, complication, functional outcomes.

Sources

1. BALOGH, Z., KING, K. L., MACKAY, P. et al. The epidemiology of pelvis ring fractures: a populationbased study. J Trauma. 2007, 63, 1066–1073.

2. DEREVJANÍK, P., RYANTOVÁ, V., DŽUPA, V. Demografická a epidemiologická studie pacientů s poraněním pánve. Rozhl Chir. 2007, 86, 423–427.

3. DŽUPA, V., CHMELOVÁ, J., PAVELKA, T. et al. CISP INVESTIGATORS: Multicentrická studie pacientů s poraněním pánve: základní analýza souboru. Acta Chir Orthop Traum Čech. 2009, 76, 404–409.

4. DŽUPA, V., RYANTOVÁ, V., SKÁLA-ROSENBAUM, et al. Infekční komplikace operační léčby zlomenin pánve. Acta Chir Orthop Traum Čech, 2008, 75, 293–296.

5. KABAK, S., HALICI, M., TUNCEL, M. et al. Functional Outcome of the Open Reduction and Internal Fixation for completely Unstable Pelvic Ring Fractures (Type C): A Report of 40 Cases. J orthop Trauma. 2003, 17, 555–562.

6. MAJEED, S. A. Grading the Outcome of pelvis Frac-tures. J Bone Joint Surg. 1989, 71-B, 304–306.

7. MATTA, J. M., TORNETTA, P. 3rd.: Internal Fixation of Unstable Pelvic Ring Injuries. Clin Orthop. 1996, 329, 129–140.

8. NOVÁK, K. Patogeneze průběhu chirurgické infekce. In: NOVÁK, K., CHUDÁČEK, Z., NEORAL, Č. (Eds): Infekce v chirurgii. Praha: Grada. 2001, 13–16.

9. PAVELKA, T., DŽUPA, V., ŠTULÍK, J. et al. Výsledky operační léčby nestabilního poranění pánevního kruhu. Acta Chir Orthop Traum. Čech. 2007, 74, 19–28.

10. RAF, L. Pelvic Ring Injuries. A Challenge for the Trauma Surgeon. Acta chir Belg. 1996, 96, 78–84.

11. ROMMENS, P. M., HESSMAN, M. H. Staged Reconstruction of Pelvic Ring Disruption: Differences in Morbidity, Mortality, Radiologic Result, and Functional Outcomes between B1, B2/3, and C-Type Laesions. J Orthop Trauma. 2002, 16, 92–98.

12. ROUTT, M. L. Jr., SIMONIAN, P. T., GRUJIC, L. The retrograde Meduallary Superior Pubic Ramus Screw for the Treatment of Anterior Pelvic Ring Disruption: A New Technique. J Orthop Trauma. 1995, 9, 35–44.

13. ROUTT, M. L., NORK, S E., MILLS, W. J. Highenergy pelvic ring disruptions. Orthop Clin N Amer. 2002, 33, 59–72.

14. SCHMAL, H., MARKMILLER, M., MEHLHORN, A. T.et al. Epidemiology and Outcome of complex Pelvic Injury. Acta Orthop Belg. 2005, 71, 41–47.

15. TALLER, S., LUKÁŠ, R., ŠRÁM, J. et al. 100 CT navigovaných operací pánve. Acta Chir Orthop Traum Čech. 2003, 70, 279–284.

16. WEBER, G. B. Asepsis and the risk of infection. In: WEBER, G. B. (Ed.): Minimal fracture fixation. Davos Platz: AO Publishing, 2004, 1–18.

17. YINGER, K., SCALISE, J., OLSON, S. et al. Biomechanical Comparison of Posterior Pelvic Ring Fixation. J Orthop Trauma. 2003, 17, 481–487.

Labels

Surgery Traumatology Trauma surgery

Open reduction and internal fixation in dislocated intraarticular calcaneal fractures

The use of modern angular stable implants in fractures of the distal humerus

Isolated pancreas injury of the 22-years-old man caused by blunt abdominal trauma

Article was published in

Trauma Surgery

2011 Issue 1