A REVIEW OF THE TREATMENT OF PELVIC RING FRACTURES

Abstract

The aim of the study: The authors are going to compare three treatment methods of ring pelvic fractures: operative, non-operative and with the use of an external fixator.

Material and methods: Between 1995 and 2005, 395 patients with pelvic ring fractures were treated at our department. 131 patients took part in this study. There were 84 (64,1%) males and 47 (35,9%) females. The common reason of the injury were car accidents 98 patients (74,8%), the second were falls 23 (17,5%), crush 7 (5,4%) and others 3 (2,3%). All patients were initially evaluated with use of three standard plain radiographs (anterioposterior radiograph, inlet and outlet projection according Penal & Tile) and computerized tomography scans and three-dimensional reconstructions of the scans. These studies were used to classify the fractures according to the classification of Young-Burgess. There were LC I 24, LC II 30, LC III 2, APC I 8, APC II 22, APC III 8, VS 10, CMI 27 fractures. 39 patients (29,8%) were treated no operatively, 48 patients (36,6%) were treated with use of the external fixator, 18 (13,7%) patients were treated by combination of open reduction and fixation with additional external fixation, and the rest of patients (26, 19,9%) were treated by open reduction and fixation.

Results: The clinical results were evaluated according to the Majeed scale. Long term clinical results were for individual type of fractures: LC I- 14 excellent, 6 good, 4 fair, 0 poor;

• LC II- 11 excellent, 6 good, 8 fair, 5 poor; LC III- 0 excellent, 2 good, 0 fair, 0 poor;

• APC I- 5 excellent, 2 good, 1 fair, 0 poor; APC II- 14 excellent, 5 good, 3 fair, 0 poor;

• APC III- 3 excellent, 0 good, 4 fair, 1 poor; VS- 5 excellent, 2 good, 3 fair, 0 poor;

• CMI- 9 excellent, 7 good, 7 satisfactory, 4 poor,

Conclusion: A comparison of the non-operative and operative methods showed that anatomical open reduction and fixation gave the shortest time of treatment and better clinical results. The anatomical reduction and fixation the posterior parts of the pelvic is the key to good long term clinical result of treatment.