Surgical treatment of unstable combined fractures of pelvis and acetabulum / 中华创伤骨科杂志

ABSTRACT

Objective To explore the treatment and clinical outcomes of unstable combined fractures of pelvis and acetabulum.Methods From January 2013 through December 2014,21 unstable pelvic fractures associated with acetabular fractures received surgical treatment at our department.They were 18 men and 3 women,aged from 21 to 55 years (average,43.2 years).By the Tile classification for pelvic fractures,12 cases were type B and 9 type C.By the Letourel-Judet classification for acetabular fractures,11 cases were transverse fractures,5 both-column fractures,3 posterior column + posterior wall fractures,and 2 anterior column fractures.The intervals between injury and surgery averaged 6.5 days (from 4 to 15 days).Results The 21 cases were followed up for 6 to 18 months (average,9 months).According to the Matta's criteria for pelvic reduction,5 cases were excellent,12 good,and 4 fair,giving an excellent to good rate of 81.0％.According to the Matta's criteria for acetabular reduction,5 cases were excellent,11 good,and 5 poor,giving an excellent to good rate of 76.2％.The pelvic fractures healed after 12 to 18 weeks (average,14.5 weeks);the acetabular fractures healed after 12 to 22 weeks (average,15.5 weeks).According to the Majeed's functional evaluation at the last follow-ups,10 cases were excellent,8 good and 3 fair,giving an excellent to good rate of 85.7％.According to the Merle d'Aubigné-postel evaluation,8 cases were excellent,9 good,and 4 fair,giving an excellent to good rate of 81.0％.Three patients had nerve injury which was almost completely recovered 4 to 6 months after operation.Two cases had wound infection which was controlled after debridement for twice.No other complications like ectopic ossification,avascular necrosis of the femoral head,iatrogenic vascular or nerve lesion was observed during the follow-ups.Conclusion Precise diagnosis,rational plan,careful surgery,effective reduction,rigid fixation and active rehabilitation are keys to fine outcomes in the treatment of unstable pelvic fractures associated with acetabular fractures.