[Follow-up study on patients of failed internal fixation after anterior pelvic ring fracture surgery]

To explore the causes of internal fixation failure after reduction and internal fixation of anterior pelvic ring fractures and dislocations.

A retrospective analysis was conducted on 5 male patients with anterior pelvic ring fractures treated with plate and screw internal fixation from May 2022 to May 2023, aged from 55 to 60 years old;2 patients caused by traffic injuries, 1 patient caused by falling down, and 2 patients caused by falls injury; 3 patients were type B and 2 patients were type C according to Tile classification of pelvic fractures;2 patients with intra-abdominal organ injury, 1 patient with craniocerebral injury, 1 patient with upper limb fracture, and 2 patients with type 2 diabetes;the time from injury to operation ranged from 6 to 12 days. Failure of internal fixation after surgery was observed, Matta scoring standard at the latest follow-up was used to evaluate postoperative imaging data, and Majeed scoring was used to evaluate functional recovery.

All patients were followed up for 9 to 12 months. All 5 patients showed signs of internal fixation loosening and fracture displacement on imaging within 1 week to 1 month after operation. Immediately after operation, X-ray plain films were reexamined, 5 patients were evaluated as excellent according to Matta scoring standard. Two patients had internal fixation failure at 1 week after operation, and 3 patients had internal fixation failure at 1 month after operation. The main manifestations were internal fixation displacement, screw withdrawal, and fracture displacement. The reduction quality was evaluated according to Matta score, 1 patient got excellent result and 4 good. At the latest follow-up, 5 patients were excellent according to Majeed scoring standard.

When treating anterior pelvic ring fractures and dislocations through surgery, the internal fixation device may become loose or break. This complication could be reduced by choosing more suitable implants, performing more complete surgical procedures, improving patient compliance, and conducting reasonable postoperative rehabilitation. Postoperative loosening and fracture of internal fixation occurred, and most of them were within the range of excellent evaluation. The final follow-up results were mostly excellent. If necessary, the removal of internal fixation can be performed.