[Chronic instability of the pubic symphysis : Etiology, diagnostics and treatment management]

Pelvic post-traumatic asymmetry: Assessment and sequenced treatment

The most common cause of post-traumatic pelvic asymmetry is, by far, initial nonoperative treatment.

Open reduction and internal fixation of unstable pelvic fractures are recommended to avoid pelvic nonunion or subsequent structural deformities.

The most common symptom is pelvic pain. Pelvic instability is another symptom, as well as persistent urogenital problems and neurological sequelae.

Preoperative evaluation of these patients requires careful clinical and functional assessment, in addition to a complete radiological study.

Surgical treatment of pelvic fracture nonunions is technically demanding and has potentially serious complications.

We have developed a new classification that modifies and completes Mears and Velyvis’s classification in which we highlight two types of post-traumatic sequelae with different clinical conditions and whose basic differentiating element is whether pelvic deformity is present or not. Based on this classification, we have established our strategy of surgical treatment.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170069.

Late reconstruction of severe open-book deformities of the pelvis - tips and tricks

BACKGROUND

The primary goal of treatment for open book pelvic injuries after high-energy trauma is to control haemorrhage and to close the pelvic ring anatomically. Less commonly, patients may present late with malunion or non-union.

METHODS

We reviewed five operatively treated patients with delayed severe open book deformities who had a diastasis of more than 6 cm. We describe the pre-operative workup, surgical strategy and challenges experienced. They specifically include: extensive scar and contracture formation, malunion, urogenital prolapse and difficult reduction of vertical shear element. A 5 to 15-point clinical scoring system based on quality of life regarding pain, ambulation, social function, continence control and presence of prolapse is proposed.

RESULTS

One elderly patient had early mortality after surgery. The other four patients had quality of life improvement by 3 to 5 points after one year. Correction is often clinically successful despite technical challenges and unpredictable radiological results.

CONCLUSION

External fixator and the C-clamp are good reduction tools. Powerful implants should be used and fixation of the posterior ring is mandatory. Staged urogenital and pelvic floor reconstruction is recommended before bony reconstruction to minimize the risk of wound contamination. Patients receiving this complex procedure have a good chance for improvement in pain and functional status.