eMedicine Specialties > Orthopedic Surgery > Hip

Unstable Pelvic Fractures: Follow-up

Author: Kenneth W Graf Jr, MD, Consulting Surgeon, Department of Orthopedic Trauma Services, Mission Hospitals
Coauthor(s): Madhav Karunakar, MD, Consulting Surgeon, Section of Orthopedic Surgery, Department of Surgery, University of Michigan Medical Center
Contributor Information and Disclosures

Updated: Jan 18, 2008

Outcome and Prognosis

The long-term functional outcome after pelvic ring injury has not been well reported. The natural history of unstable pelvic fractures treated nonoperatively has demonstrated a high incidence of residual disability, severe low back pain, and pelvic obliquity and gait disturbances.35

Henderson presented 26 patients with nonoperatively treated pelvic fractures with a minimum of 5-year follow-up.36 Subjective symptoms included frequent or daily low-back discomfort (50%), localized dysesthesias (46%), and work disability (38%). Objective findings included neurologic deficits (42%), motor weakness or abnormal deep tendon reflexes, and persistent limp (32%). Long-term outcomes correlated well with the amount of residual vertical displacement and the stability of the fracture.

Semba et al also found a correlation between displacement on the initial film and residual symptoms.37 Patients with a combined AP and vertical displacement of less than 1 cm at initial injury were asymptomatic, whereas those with a displacement at injury greater than 1 cm had an increased frequency of late severe low-back pain.

Gruen et al studied the outcome of patients with multiple injuries that included unstable pelvic ring injuries who were treated with ORIF.38 In this study, 62% of patients returned to work full time, and most patients with pelvic fractures (77%) had mild disability at 1 year. Persons with open-book injuries tended to have higher individual and total Sickness Impact Profile scores than individuals with lateral compression fracture despite similar Injury Severity Scores.

Tornetta et al reviewed 29 patients with rotationally unstable but vertically stable pelvic ring injuries treated with ORIF with more than 3 years of follow-up.39 The primary indication for surgery was symphyseal disruption. Follow-up evaluation revealed that 96% had no pain or pain only with strenuous activity. Seventy-six percent ambulated without assistance or limitations, and 76% returned to their preinjury occupation.

Copeland et al40 found that women with pelvic fractures have higher rates of urinary symptoms, cesarean deliveries, and gynecologic pain (20%) than a matched group of female patients with multitrauma without pelvic fractures. Twenty-one percent of women with pelvic fractures had urinary tract symptoms despite a low incidence of frank genitourinary injuries. Copeland et al postulate that the significant incidence of stress incontinence is due to the disruption of the pelvic floor musculature or interruption of its innervations. Urinary tract symptoms were more common in patients with residual pelvic fracture displacement in a lateral or vertical direction as opposed to medial direction. The pelvic floor becomes redundant in individuals with lateral compression injuries, whereas in persons with APC or VS injuries, the pelvic floor is placed under tension and can be disrupted.

McCarthy et al found that women with pelvic fractures scored lower on all dimensions, except mental health, of the 36-Item Short Form Health Survey (SF-36), as compared to age- and sex-standardized norms.41

The outcome of unstable pelvic fractures appears to vary on the basis of the initial displacement, fracture classification, and associated injuries. Long-term outcome studies are required to better determine how operative intervention alters the natural history of these severe injuries.

Future and Controversies

Over the past 30 years, major progress has been made in understanding and treating unstable pelvic fractures. The improved techniques in ORIF, as well as the percutaneous fixation techniques developed, have aided greatly in the treatment of these fractures. Because of the relatively recent use of these treatments, the reporting of more long-term results of treatment is essential. These studies will direct the future treatment of unstable pelvic fractures. Continued improvements in the multidisciplinary treatment of patients with such injuries will be crucial to further decreasing the high morbidity and mortality rates associated with these severe injuries.

 


More on Unstable Pelvic Fractures

Overview: Unstable Pelvic Fractures
Workup: Unstable Pelvic Fractures
Treatment: Unstable Pelvic Fractures
Follow-up: Unstable Pelvic Fractures
Multimedia: Unstable Pelvic Fractures
References
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References

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Further Reading

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Keywords

open-book fractures, Tile type B fractures, anterior-posterior compression injury, APC injury, lateral compression injury, LC injury, vertical shear injury, VS injury, combined mechanism injury, zone I sacral injury, zone II sacral injury, zone III sacral injury, pelvic fracture, fracture of the pelvis, acetabular fractures, lateral compression fractures, transverse fractures of the pubic rami, avulsion fracture, Young classification system, anterior-posterior compression fractures, anteroposterior compression fractures, pelvic ring injuries, broken pelvis, cracked pelvis, shattered pelvis, fractured hip, broken hip

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Contributor Information and Disclosures

Author

Kenneth W Graf Jr, MD, Consulting Surgeon, Department of Orthopedic Trauma Services, Mission Hospitals
Disclosure: Nothing to disclose.

Coauthor(s)

Madhav Karunakar, MD, Consulting Surgeon, Section of Orthopedic Surgery, Department of Surgery, University of Michigan Medical Center
Madhav Karunakar, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and AO Foundation
Disclosure: Nothing to disclose.

Medical Editor

B Sonny Bal, MD, Associate Professor, Department of Orthopedic Surgery, University of Missouri School of Medicine
B Sonny Bal, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James J McCarthy, MD, FAAOS, FAAP, Associate Professor, Consulting Orthopedic Surgeon, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health;
James J McCarthy, MD, FAAOS, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Orthopaedic Association, Limb Lengthening and Reconstruction Society ASAMI-North America, Orthopaedics Overseas, Pediatric Orthopaedic Society of North America, Pennsylvania Medical Society, Pennsylvania Orthopaedic Society, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

William L Jaffe, MD, Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Vice Chairman, Department of Orthopedic Surgery, New York University Hospital for Joint Diseases
William L Jaffe, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, Eastern Orthopaedic Association, and New York Academy of Medicine
Disclosure: Stryker Orthopaedics Consulting fee Speaking and teaching

 
 
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