TWO-PHASE SURGERY FOR MISALIGNED HEALING OF PELVIC FRACTURES

Abstract

Purpose of the study: Misalignment after insufficient treatment of unstable fracture of the pelvis is often poorly tolerated, compromising quality-of-life due to limping, leg length discrepancy, posterior pain, uncomfortable sitting position and/or sexual disorders due to mechanical problems. Secondary surgical treatment can be proposed despite its invasive nature (generally three phase surgery). The purpose of this work was to present the technique and the results of standardized correction of pelvis misalignment using a two-phase procedure.

Material and methods: Eight consecutive patients (May 2002–May 2004) with sequelae of Tile C fractures were treated on average eight years after the initial trauma. A double-approach was used. The series included four men and four women, aged 18–43 years. The first posterior approach in the ventral supine position was used for osteotomy of the sacroiliac callus and systematic debridement by section of the sacroiliac ligaments. The secondary ilioinguinal approach was performed in the dorsal supine position to achieve osteotomy of the symphyseal callus, reduction of the iliac wing, and symphyseal synthesis using a sacroiliac plate anteriorly and percutaneous screws.

Results: The mean operative time was four hours 30 minutes. Blood loss required transfusion of 3.5 packed red cell units on average. Anatomic reduction was achieved in six cases, partial reduction in two. Despite one nosocomial infection and two partial popliteal external sciatic deficits, all patients wer satisfied with the operation at mean eight months follow-up. Bone healing was achieve din all cases.

Discussion: Standard two-phase surgery is possible for a wide range of cases. The anatomic result is reliable with good clinical outcome. The duration of the operation and blood loss are reduced compared with classical techniques.

Conclusion: Despite the advantage of this original operative strategy, surgery for correction of pelvis misalignment remains a difficult surgical procedure for selected and motivated patients informed of the operative risks.