Evaluation of functional results of fixation of unstable open-book pelvic fractures by external and internal fixation

ABSTRACT

This study was performed to evaluate the functional results of unstable open-book pelvic fractures in adults by external fixator and internal fixation. 15 patients were included in the study, 12 males and 3 females who were admitted to the Suez Canal university hospital. The average age was 45 years [22-63]. The mechanism of injury was motor car accident in 10 patients and 5 were pedestrians. Adult patients with recent unstable open-book pelvic ring injuries with diastasis at the symphysis pubis more than 2.5 cm were included with exclusion of open fractures and fractures of lower extremities. For each patient, history taking for mechanism of injury, clinical examination, and radiological evaluation as a preoperative assessment was done. Radiographic assessment through anteroposterior view, inlet view and outlet views were done for every patient to identify pelvic ring injuries. Also CT was done for every patient to identify any posterior pelvic ring injuries. In most of the cases the symphysis pubis was fixed first using Pfannenstiel's approach followed by applications of the esternal fixator frame. The patient's average hospital stay was 14 days]10-18 days]. The different methods of fixation were evaluated according to a system of functional scoring by Majeed. Anatomical results of patients post-operatively at one year revealed excellent results in 10 patients [67%] and good results in 4 patients [27%], and one patient has fair results [6%] due to displacement at the sacroiliac joint. The functional results were excellent in 12 patients [80%] good in 2 patients [14%] and fair results in one patient [6%]. Post-operative local complications in two patients [14%] as pin tract superficial infection. The technique of combined external fixation of the posterior ring and anterior fixation by a single-plate for unstable open-book pelvic fractures is an easy method and gives satisfactory anatomical and functional results: