[Outcome evaluation after unstable injuries of the pelvic ring]

Open reduction followed by internal fixation is the method of choice after unstable pelvic ring fractures and gives better results than either conservative treatment or external fixation alone. Even after anatomic reconstruction of the pelvic ring, however, a high incidence of late sequelae is reported, especially after C-type fractures (translational instability). The purpose of the study reported in this paper was evaluation of a new scoring system for the rating of the long-term outcome after pelvic fractures. In all, 28 B-type fractures and 27 C-type fractures (Tile) were subjected to surgical stabilization in 1985-1990 (both external and internal stabilizations). These patients were followed up clinically and radiologically an average of 28 months after injury. The results were summarized in a new pelvic outcome score. The scoring included the radiological result (I = max. 3 points) and the clinical result with rating of function, neurological, urological and sexual deficits (II = max. 4 points). The "critical value" for the radiological evaluation was a 5-mm residual posterior displacement or a 15-mm anterior displacement in the pelvic ring defining a "poor" result (1 point). Social reintegration, an overall reflection of all accident-related sequelae, was rated independently (III = max. 3 points). I + II were summarized as "pelvic outcome," with 7 points rated as excellent, 6 points as good, 5 and 4 points as moderate, and 3 and 2 points as a poor result. Freedom from pain was achieved in 89% of the patients who had B-type injuries, and in 30% of those with C-type injuries. Neurological deficits were seen in 32% after B-type (only sensory) and 70% after C-type fractures (33% motor nerve, 37% sensory). The maximum radiological rating was given to 86% of the patients after B-type and 27% after C-type injuries. The clinical rating was maximum (4 points) in 18% after B-type and 7% after C-type fractures, resulting in a good or excellent rating for "pelvic outcome" in 79% after B-type and only 27% after C-type injuries. The maximum rating for social reintegration was given to 57% after B-type and 44% after C-type injuries. Even after anatomical reconstruction of the pelvic ring in C-type fractures (3 points) 20% of the patients were clinically rated as "poor" (1 point). The study showed that anatomic reconstruction of the pelvic ring is an important factor in a good or excellent clinical result, but even when this goal is met, other parameters (sacral fractures, SI dislocations, primary neurological/urological injuries) can lead to an unsatisfactory result. The new rating system is comprehensive and easy to apply and allows a clear differentiation of typical late sequelae after pelvic injuries; it will therefore be used for further long-term studies.