Surgical Treatment Of Unstable Pelvic Fractures

Objective:To study the clinical results of open reduction and internal fixation for rotationalty and vertically unstable pelvis ring fractures with Different surgical approach. Method:A retrospective study was done for the 31 patients with unstable pelvic ring fractures who had receive do perative treatment from January 2002 to December 2008 and complete follow-up. according to Tile classification, there were 8 cease of type B(B1:3; B2:3; B3:2)and 23 type C(C1:4; C2:3; C3:16), and 23patients with acetabular fractures, Five patients with associated lumbesacral plexus injury before operation. Ilioinguinal approach were used in 13 cases, anterior and Posterior combined approach were used in 11 cases, expand the iliofemoral approach in 1 case, the pubic symphysis anterior surgical approach (Pfannen-stiel incision) in 2 cases, alone sacroiliac joint lateral approach in 4 cases. Simple anterior ring fixation Was applied in 14patients, simple posterior ring fixation in 4 patients and combined anterior and posterior fixation in 13 patients. The functional outcome was evaluated using Majeed. Result:The mean follow-up Was 3.0(1.0 to 5.0)years for the al 31 patients. at the time of final follow-up, the mean Maieed score was 82.7(58 to 100). The clinical outcome Was excellent in 16 patients,good in 11, fair in 4 and poor in 0. The overall good to excellent rate Was 87.1%. Of the 17 eases witll associated acetabular fractures that were operatively treated。14 were graded good and excellent. Of the 5 patients with associated lumbesacral plexus injury before operation。3 cease obtained full recovery,2 partial recovery and 0 no recovery.mplant failure no occurred. Conclusion:Good clinical results can be expected with operative treatment for unstable pelvic ring fractures. Severe lumbosacral plexus injury, implant failure, different operative routes and associated acetabular fracture are risk factors for all unsatisfactory clinical result.