Functional outcome of internal fixation for pelvic ring fractures

Objective: Evaluation of the functional outcome after unstable pelvic ring fractures stabilized with internal fixation. Methods: Between January 1, 1990, and September 1, 1997, 37 patients were t reated with internal fixation for unstable pelvic fracture, Demographic dat a, type of accident, Hospital Trauma Index-Injury Severity Score, and fract ure type according to Tile classification were scored. One patient died the day after the accident from neurologic injury, A Short Form-36 health ques tionnaire and a form regarding functional result after pelvic trauma, adapt ed from Majeed et al., were returned by 31 of 36 patients (86%). Twenty-eig ht patients (78%) were seen for physical and radiologic examination, Results: Twenty-six men and 11 women, with an average age of 34.7 years (ra nge, 15-66 years) were included. The mean Injury Severity Score reached 30. 4 (range, 16-66), According to the Tile classification, there were 16 type B fractures and 21 type C fractures. Seven patients were treated with open reduction and internal fixation of the pubic arch, 10 patients were treated with a combination of anterior open reduction and internal fixation with a dditional external fixation to increase the stability of the posterior ring . Nineteen patients underwent internal fixation of both anterior and poster ior arch. In the remaining case, percutaneous posterior screw fixation was combined with anterior external fixation, because of estimated infectious r isk, The average follow-up time was 35.6 months. Patients scored 78.6 of 10 0 on the Majeed score, Remarkable was the reported change in sexual interco urse in 12 patients (40%). Only 12 patients (40%) did not have complaints w hen sitting. On the SF-36 scales physical and social functioning, role limi tations due to physical problems and vitality were limited compared with th e averages for the Dutch population. Patients treated with combined anterio r and posterior internal fixation scored significantly better on both the M ajeed score and on the categories physical functioning, pain, general healt h and social functioning compared with patients with similar fractures trea ted with a combination of anterior internal fixation with external fixation . At the physical examination, 11 of 28 patients (39%) did not have any abn ormality. Nineteen patients (68%) were back at their original job, which wa s physically demanding in 9 cases, There was a suspicion of nonunion of the posterior arch in two patients, which could be confirmed with a computed t omographic scan. Conclusion: In general, limitations in functioning are reported, even after long-term follow-up, In partially unstable fractures, solitary anterior fi xation gives good results, In completely unstable fractures, patients treat ed with combined internal fixation anterior as well as posterior scored a b etter outcome compared with combined internal and external fixation, Theref ore, this technique is recommended as treatment of first choice in complete ly unstable fractures.