OUTCOME EVALUATION AFTER SURGICAL STABILI ZATION OF UNSTABLE PELVIC RING FRACTURES

Open reduction followed by internal fixation is the method of choice a fter unstable pelvic ring fractures and gives better results than eith er conservative treatment or external fixation alone. Even after anato mic reconstruction of the pelvic ring, however, a high incidence of la te sequelae is reported, especially after C-type fractures (translatio nal instability). The purpose of the study, reported in this paper was evaluation a new scoring system for the rating of the long-term outco me after pelvic fractures. In all, 28 B-type fractures and 27 C-type f ractures (Tile) were subjected to surgical stabilization in 1985-1990 (both external and internal stabilizations). These patients were follo wed up clinically and radiologically an average of 28 months after inj ury. The results were summarized In a new pelvic outcome score. The sc oring included the radiological result (I=max. 3 points) and the clini cal result with rating of function, neurological, urological and sexua l deficits (II=max. 4 points). The ''critical value'' for the radiolog ical 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-r elated sequelae, was rated independently (III=max. 3 points). I+II wer e 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. Neurol ogical deficits were seen in 32% after B-type (only sensory) and 70% a fter C-type fractures (33% motor nerve, 37% sensory). The maximum radi ological 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 1 8% 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 2 7% after C-type injuries. The maximum rating for social reintegration was given to 57% after B-type and 44% after C-type injuries. Even afte r 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 dislocat ions, primary neurological/urological injuries) can lead to an unsatis factory result. The new rating system is comprehensive and easy to app ly and allows a clear differentiation of typical late sequelae after p elvic injuries; it will therefore be used for further long-term studie s.