Related Experiment Videos
The operative treatment of unstable pelvic ring fractures
P Broos1, P Vanderschot, L Craninx
1Department of Traumatology and Emergency Surgery, University Hospitals, Katholieke Universiteit, Leuven, Belgium.
Insights
High-energy pelvic ring injuries can cause severe bleeding and functional loss. Type C injuries are linked to worse outcomes than Type B, often requiring further internal fixation after initial external stabilization.
Area of Science:
- Orthopedic Surgery
- Trauma Management
- Musculoskeletal System Injuries
Background:
- Pelvic ring disruptions from high-energy trauma pose significant risks, including life-threatening hemorrhage and long-term functional deficits.
- Injury severity and type correlate with blood loss, associated injuries, and patient outcomes.
Purpose of the Study:
- To evaluate the outcomes of treating unstable pelvic ring injuries (Tile's Type B and C).
- To assess the efficacy of external fixation as an initial stabilization method.
Main Methods:
- Retrospective analysis of 44 patients with unstable pelvic ring injuries (Type B or C) treated between 1987 and 1989.
- Initial management involved external fixation (Monofixateur) in 28 cases, followed by CT scans and semi-elective internal fixation when necessary.
Main Results:
- Overall mortality was less than 7%.
- Type C injuries showed a significantly higher incidence of pain, permanent deformity, and diminished function compared to Type B injuries (p < 0.05).
- External fixators effectively reduced bleeding but could not maintain reduction in rotationally and vertically unstable lesions.
Conclusions:
- External fixation is a useful temporary measure for unstable pelvic ring injuries, primarily for hemorrhage control.
- Type C pelvic ring injuries have poorer functional outcomes and higher complication rates than Type B injuries.
- CT-guided semi-elective internal fixation is often required for definitive treatment of unstable pelvic ring injuries, especially Type C.
Abstract:
Pelvic ring injuries due to high energy forces are among the most serious, involving the musculoskeletal system. Life threatening hemorrhage, local and distant associated injuries, deformity, pain and diminished functional capacity are all potential problems for a patient with a disrupted pelvis. There is a clear correlation between total blood loss, incidence of associated injuries, final functional result and the type of pelvic ring injury. Between January 1987 and July 1989, 44 patients with an unstable lesion, type B or type C in Tile's classification have been treated in the University Hospital Gasthuisberg of the Katholieke Universiteit Leuven. In 28 cases, primary stabilisation was done by means of an external fixator, "Monofixateur" type. The overall mortality rate was less than 7%. Thirty-five patients could be seen for follow-up six months to three years after injury. Our findings confirm that compared to type B lesions there is a higher incidence of pain, permanent deformity and diminished functional capacity in type C lesion (p < 0.05). The external fixator, used in the immediate post injury period provides an effective splint that reduces bleedings from bone and veins but cannot maintain reduction in lesions with rotational and vertical instability. In these cases, a semi-elective internal fixation, after defining the exact patho-anatomy by means of a CT-scan has to be performed in selected areas.