Surgical management of pelvic ring disruptions. Indications, techniques and functional results

In a period of 30 months, we treated 44 pelvic ring fractures by early operative stabilization. The ratio of associated musculoskeletal and intrapelvic lesions was very high, with a mean ISS of 36.2. The perioperative mortality rate (3/44) was acceptable with 6.8%. A second osteosynthesis was performed in fast 8% of type-B and in fast 40% of type-C lesions. The average hospital stay was very short with 42.0 days. We were able to mobilize the patients very early after their admission, thanks to the quick operative stabilization of the pelvic ring and the other skeletal injuries. Of the 39 surviving patients, 35 were reviewed clinically, functionally and radiographically after a mean of 19.3 months. There was a statistically significant difference in the rate of walking difficulties, walking distance, hip mobility, muscle force and the functional end-results between patients with type-B and those with type-C lesions. Lesions of type B are benign and can be adequately treated by the application of an anterior external fixator frame alone. The functional results are excellent or good in the great majority of cases. The type-C lesions are much more difficult to deal with. The anterior external fixator provides insufficient stability in many cases. It must be supplemented by posterior fixation or exchanged for anterior and posterior internal fixation. Even then, many patients with type-C lesions have functional disabilities and subjective complaints after treatment.