Persistent impairment after surgically treated lateral compression pelvic injury

Abstract

Background: Recently, fixation of lateral compression (LC) pelvic fractures has been advocated to improve patient comfort and to allow earlier mobilization without loss of reduction, thus minimizing adverse systemic effects. However, the degree of acceptable deformity and persistence of disability are unclear.

Questions/purposes: We determined if (1) injury pattern; (2) demographics; (3) final posterior displacement; (4) L5/S1 involvement; (5) associated injuries; and (6) time influence outcome measurements, sexual dysfunction, and pain.

Methods: We retrospectively reviewed 119 patients with unstable LC injuries treated surgically between 2000 and 2010. There were 52 males and 67 females; mean age was 39 years with a mean body mass index of 27 kg/m(2). All patients underwent clinical examination and radiographic imaging for instability and accompanying injuries. We obtained Short Musculoskeletal Function Assessment (SMFA). The minimum followup was 12 months (mean, 33 months; range, 12-100 months).

Results: SMFA subscores were not affected by injury pattern and demographics. Posterior reduction was less than 5 mm with persistent displacement in 99 of 119 (83%). Displacement of 5 to 10 mm did not affect any SMFA subscore at any time interval. Patients with additional lower extremity injuries had worse SMFA scores. Function improved with time. A visual analog scale pain score of 4 or more at 6 months predicted pain and overall SMFA score at last followup.

Conclusions: Unstable LC pelvic ring injuries result in persistent disability based on validated outcome measurements. Near anatomical reduction can be achieved and maintained. While our findings need to be confirmed in studies with high rates of followup, patients with unstable LC pelvic injuries should be counseled concerning the possibility of some degree of persistent disability.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Figures

Fig. 1A–E

An example of a typical injury pattern and treatment. (A) Preoperative injury radiograph. (B) Preoperative axial CT demonstrating the instability with complete sacral fracture pattern. (C–D) Postoperative inlet and outlet views demonstrating post reconstruction and stabilization of the pelvis initial insertion of a percutaneous right sacroiliac (SI) partially threaded screw to compress and stabilize the SI joint, temporary femoral distractor to disimpact the LC, sacral stabilization of the left sacral fracture with a fully threaded left SI screw, and final percutaneous retrograde ramus screw. (E) Postoperative CT illustrating the sacral reduction and screw fixation.

Fig. 2

Patients were treated with posterior and anterior fixation implants based on their injury pattern. ORIF = open reduction and internal fixation; Ex fix = external fixation.

Fig. 3

Functional outcome measurements, SMFA, for operatively treated LC pelvic ring injuries show improvement but does not return to normal.

Fig. 4

Functional outcome of bother index and dysfunction index of operatively treated LC pelvic ring injuries shows persistent impairment compared with normative data and other orthopaedic conditions. UE = upper extremity; LE = lower extremity; fx = fracture.