Early or late open reduction and internal fixation of pelvic ring fractures

ABSTRACT

Open reduction and internal fixation [ORIF] was performed on 33 patients in Sunnybrook Health Science Centre, Toronto, Canada, in the period of January 1990 to January 1991. They were '7 females and 26 males. Their age was 13 - 79 years. [ORIF] was done early [EORIF], ie within 72 hours from the time of the accident in 15 patients [45.4 7%], or late [LORIF] in 18 patients [54.6%]. The cases were studied retrospectively. The findings were as follows. All 33 patients had multiple abdominal or skeletal injuries. The types of pelvic fractures were In EORIF group AP compression 2; Lateral compression 1; Vertical shear 7; Complex 2; Acetabular ring disruption 3. In LORIF group the respective numbers were 0, 0, 9, 1, 8. Emergency preoperative evaluation CT scan, abdominal and pelvic 83 patients; Angiography in 8 EORIF and 6 LORLF patients with suspected significant retroperitoneal haemorrhage which was confirmed in 5 and 3 cases respectively. EORIF group delay in being operated whole group's average 38 hours; in 7 it was possible within 24 hours. In the LORIF group the average was 7.8 days. Measures to recover the general condition Days on respirator EORIF avenge 3 days, range 0 - 14 days; LORIF average 1 day, range 0 - 2. Days confined to bed EORIF 5.8, 2 - 31; LORIF 12.5, 2 - 60 respectively. Days of hospitalisation EORIF 32.0, 10 - 90; 37.0, 10 - 95 respectively. Complications Pulmonary EORIF 2, LORIF 4; Urinary tract infection 6 and 4; Deep vein thrombosis 2 and 0; Wound infection 2 and 5; Other complications 5 and 4, respectively. Six patients were excluded from above averages, 2 in EORIF group and 4 in LORIF group, because they were confined to bed for prolonged periods due to complications. One case died in EORIF group on the 12th postoperative day from uncontrolable massive retroperitoneal haemorrhage. It is concluded that EORIF in centres well prepared for it has many advantages over LORIF that allow recommendation of its use