Clinical Effect And Experience Of Lumbopelvic Fixation In Treament Of Pelvic Type C Fractures And Complex Sacral Fractures

Objective: To evaluate the clinical effect and accumulate the experience of lumbopelvic fixation in treament of pelvic Type C fractures and complex sacral fractures by follow-up.Methods:A retrospective study was performed on 19 cases of pelvic Type C fractures or complex sacral fractures who had been treated with lumbopelvic fixation from march 2014 to December 2016 in our hospital.19 patients with an average of 34.1 years(range 12 from 61 years)with pelvic Type C fractures or complex sacral fractures.Of them,three cases were classified as C1,five as C2 and eleven as C3 according to the Tile classification.Sacral fractures were classified according to the Denis classification,five of them were zone I fractures,seven of them were zone II fractures,seven of them were zone III fractures.Two patients had neurological deficits.Posterior pelvic ring and sacral fractures were surgically treated by lumbopelvic fixation,and anterior pelvic ring were fixed by plates.Sacral decompression was performed if nerve compression was diagnosed by physical or imageology examination.The vertical displacement and functional outcomes were assessed by Matta and Majeed system score respectively.Result: All 19 patients were followed up on average of 12.5 months.All the fractures were healed at average 19 weeks(range,15-32 weeks).Maximum vertical displacement was 21.80 mm with an average at 8.76 mm before surgery,while it was 12.57 mm with an average at 4.20 mm after lumbopelvic fixation.According to the Matta method,the results were excellent in seventeen cases,good in one case,fair in one case,and no poor cases with an excellent and good rate of 94.7% at last follow-up.Functional outcomes(range,60-98)were rated excellent in six patients,good in eleven patients,fair in 2 patients,and no poor patient according to the Majeed score,and the excellent and good rate was 89.4%.Deep infection occurred in two cases who were cured by debridement and antibiotics.And the internal instruments were removed after one year.Screw loose occurred in 5 cases while imageological examination or removal of internal fixator,however,one case had a breakage of connecting rod.Four patients complained prominence of the iliac hardware.Matta system score showing significant difference(P<0.05)when compared with preoperation.Conclusion: Lumbopelvic fixation was effective in surgical treatment of Type C pelvic fractures and complex sacral fractures via restoring vertical stability of pelvis.We suggested to removal of internal fixators after fracture healing because high rate of screw loose.Prominence of the iliac hardware was frequent.