Operative treatment of pelvic fractures

ABSTRACT

The goal in the treatment of pelvic fractures is to achieve and maintain reduction. Open reduction and internal fixation of the anterior pelvic ring with AO reconstruction plate performed in was 5 cases while AO tubular external fixator was used in ano-DrCh Orth Assiut Max - Landolt DrCh Surg Zurich ther cases, internal fixation was used for cases associated with laparotomy or exploration of the bladder by the general surgeons. Posterior fixation was not used in any case. The use of preoperative traction and eark surgical treatment were essential to achieve exccellent results. The procedure was not associated with an increased rate of infection or neural injury. In the 10 patients followed for an average of 17.1 months, there was no late displacement and all the fractures were healed. AO evaluation program was used and the results were one excellent, 4 good, 4 fair and one poor. Pelvic fractures usually result from high energy trauma and are often associated with several other injuries. [1] During the acute phase of management, the orthopaedic surgeon will often combine efforts with other specialists, particularly the general surgeon and the urologist. [2] The anatomy of the pelvic ring has been described in detail by many authors, who emphasized the weight bearing posterior structrues. [3] Lesions of the anterior part of the ring are less critical to the stability of the pelvic ring that is intact posteriorly. It is therefore necessary to study both survival and the natural history of the various types of pelvic trauma. [4]. The use of external fixator has expanded since it-was initially employed in Europe for stabilization of fractures of the pelvic ring. It has been reported to provide sufficient stability to allow adequate osseous healing of rotationally unstable but vertically stable fractures of the pelvic ring, particularly if an adequate initial reduction has been achieved. [5, 6] Biomechanical studies have shown that the external fixator, regardless of the configuration applied cannot stabilize the posterior disruption in an unstable pelvic ring, so some other method must be added, such as traction or internal fixation. [5, 7, 8, 9]. Anterior fixation has been used for disruption of the symphysis pubis of more than 2 centimeters, for fractures of the pubic rami with marked displacement, or after a laparotomy. [5, 6, 9]. On this paper we evaluate the results of the operative treatment of pelvic ring fractures, either by the AO tubular external fixator or by internal fixation of the anterior pelvic ring using the AO reconstruction plate, comparing the results with that reported in literatures