INTRODUCTION Delayed fixation of unstable pelvic ring disruptions is expected to have more difficulties in achieving reduction and fixation with possible higher complications. The aim of this study is to report the difficulties and evaluate the results of late fixation of vertically unstable type-C pelvic ring injuries.
METHODS This study included 22 patients with unstable pelvic fractures. Inclusion criteria were vertically unstable (type-C) pelvic injuries presented three weeks or more after the initial trauma with persistent instability, and/or fracture displacement of more than one centimeter. Time since injury ranged from 3-32 weeks. There were 18 males and four females. Age of the patients ranged from 14-58 years. According to AO based fracture classification, 18 fractures were type-C1 (unilateral), and four were type-C3 (bilateral) fractures. Eight patients had associated neurological injuries. Combined posterior and anterior pelvic fracture fixation was done in 15 patients. Posterior pelvic fixation alone was performed in seven patients. Sacral root decompression was done in five patients. Bone grafting was needed in three patients. Fusion of the sacroiliac joint was done in six patients. Radiographic assessment was done using the grading system of Matta and Tornetta, and functional outcome assessment was done using the score system of Majeed.
RESULTS All fractures healed within five months. The healing time ranged from 12 to 20 weeks (average 14 weeks). Fracture reduction was considered excellent in 15 patients (68%), good in five patients (23%), and fair in two patients (9%). Complications included transient L5 palsy in two patients, ilio-femoral DVT in one, pulled out screws in two, and superficial wound infection in two. Functional result was excellent in 16 patients (73%), good in four patients (18%) and fair in two patients (9%). Neurological improvement occurred in six out of eight patients (75%).
DISCUSSION AND CONCLUSION Delayed fixation of unstable pelvic fractures creates operative difficulties such as scar tissue, callus formation, and inability to obtain anatomic reduction. Extensive surgical exposures and soft tissue dissections are required to achieve anatomical reduction. There is need for direct open reduction of the fracture with visualization and freshening of the fracture lines. Combined posterior and anterior approaches are needed to achieve reduction and rigid stabilization of pelvic ring in these delayed cases with satisfactory outcome.