LATE RECONSTRUCTION AFTER PELVIC RING INJURIES

Pelvic malunions or nonunions are the result of inappropriate treatmen t of rotationally or linearly unstable injuries of the pelvic ring. Lo ng-term sequelae such as chronic pain in the posterior pelvic ring, ga it abnormalities, leg length discrepancy, sitting discomfort, neurolog ical problems or impingement on the visceral organs may be secondary t o the disturbed integrity of the pelvic ring. The late correction of t he deformity is technically much more demanding than the treatment of acute pelvic ring injuries. Depending on the specific problem, osteoto mies at the site of the deformity, excision of scar tissue and callus, release of ligaments, bone grafting, and an adapted technique of redu ction and fixation may be required. Possible complications include ner ve or vascular injuries, incomplete reduction of the deformity, failur e to unite, incomplete pain relief, and infection. Prior to surgery, a careful clinical and radiological examination is mandatory to assess the relationship between the presenting anatomical deformity and the c omplaints of the patient. The final decision for surgery has to be mad e by the patient taking into account reasonable expectation and the po tential complications associated with the corrective procedure.