PELVIC RING INJURIES - EPIDEMIOLOGY, THER APY AND LONG-TERM COURSE - REVIEW OF THE MULTICENTER STUDY OF THE GERMAN PELVIS GROUP

Pelvic fractures are rare injuries (3 - 8%) when compared to fractures in other body regions. They are accompanied by high mortality (5 - 20 %), and the survivors suffer from severe pain and pelvic-related handi caps. The German Pelvic Group (German Chapter of the AO-International & German Trauma Society) started a prospective multicenter study, incl uding ten major trauma centers for collecting a high number of data in a short period of time (1991-1993). All pelvic injuries were document ed consecutively using a special set of evaluation sheets. The study c losed with 1,722 patients. A 2-year follow-up was completed for 486 pa tients injured in 1991 and 1992 after type B and C injuries, complex p elvic trauma, acetabulum fractures and a random 25% of A-type injuries (overall follow-up rate 73%). The follow-up included special ''outcom e'' criteria. Of the pelvic ring injuries without significant peripelv ic soft tissue involvement, 63.6% were A-type fractures, 21.0% B-type injuries and 15.5% C-type injuries. The rate of operative stabilizatio n was 3.9% after A-type injuries, 37.3% after B-type injuries and 54.3 % after C-type injuries. In isolated acetabular fractures ORIF was per formed in 38.6%. The total lethality was 7.9% with a significant diffe rence between ''complex'' pelvic trauma (21.3%) and patients without c oncomitant peripelvic injuries (7.2%). In 0.9% the pelvic injury was r eported as the main cause of death. Pain at followup was observed in e very classification group, the rate of completely ''pain-free'' patien ts being 55% after A-type, 41% after B-type and 27% after C-type fract ures. Malfunction of micturia was reported by 7.6% of all patients, se xual malfunction by 11.6% of the males (''erectile dysfunction'') and 2.2% of the female (''dysparneuria''). Scaled by the recently develope d ''outcome score'', the radiological result showed anatomical healing after 90.8% of the B-type and 73.6% of the C-type injuries. On the ot her hand, the clinical result was rated as good or excellent in only 7 0% of the B-type and 54% of the C-type injuries. Although progress in indications and treatment techniques has shown improved radiological r esults after unstable pelvic ring injuries when compared to earlier st udies, the clinical result still remains unsatisfactory. Further analy ses and studies must be conducted to identify the prognostic factors f or the late sequelae. Whether it is possible influence these factors b y additional surgical intervention cannot be answered at present.