THE MANAGEMENT OF PELVIC NONUNION AND MAL UNION

Nonunion with or without: a late pelvic deformity remains a formidable reconstructive problem [1, 2], For the present discussion, a nonunion is defined as a failure to achieve a union of a pelvic fracture, with in six months after the time of injury, as documented by clinical and radiographic assessment, Most of the cases follow conservative managem ent or the initial application of external fixation of a displaced and unstable injury pattern. While most of the nonunions represent a comb ination of a significant traumatic event, a smaller subgroup constitut e pathological fractures or so-called ''insufficiency fractures'' of o steopenic bone [3]. By definition, the latter group represents a varie ty of pathological conditions including senile: post-menopausal and po st-irradiation osteopenia or after the harvesting of massive autologou s bone graft from the posterior ilium. Active malignancy as a factor i s wholly excluded from these cases. The present report is based upon o ur clinical experience of two hundred cases that were managed during t he past twenty year period [4]. The results constitute a summary of th e observations whereupon certain recommendations for a therapeutic pro tocol have evolved. With the unusual nature of this clinical problem a nd the great diversity of presenting problems, no attempt to randomize the treatment modalities was deemed to be realistic.