A Study on Surgical Management of Unstable Pelvic Fractures

Mageswaran, K S (2007) A Study on Surgical Management of Unstable Pelvic Fractures. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Pelvic injuries are an important aspect of orthopaedic trauma, which are caused by high velocity injuries such as road traffic accidents and industrial accidents. The management, especially those of unstable pelvic ring injuries is complex and challenging to the orthopaedic surgeon. In this study, a brief and comprehensive review of the anatomy of the pelvis, biomechanics, the mechanism of different types of unstable injury and the classification are presented followed by the clinico radiological assessment of patients with pelvic injuries and their management by various surgical modalities. We have analyzed then the outcome of these unstable pelvic injuries with surgical management. AIM: The aim of this study is to analyze the results and functional outcome of the patients with unstable pelvic fractures who were managed by surgical treatment. MATERIALS AND METHODS: Our study is an analysis of 21 cases of unstable pelvic injuries (Type B and C) managed surgically by external fixation or open reduction and internal fixation. The study period extends from October 2004 to October 2006 and conducted at the Government General Hospital and Madras Medical College, Chennai, India. All the patients with stable pelvic ring injury (tile type A) were excluded from the study. Unstable pelvic injury patients, who died before surgical intervention (3 patients) and patients who couldn’t be operated for various reasons were excluded from the study. Recently operated patients with less than three months duration at the time of conclusion of this study were excluded. RESULTS: Twenty one patients with unstable pelvic fractures were treated surgically and analyzed with an average follow up of 8.7 months (range 3-16 months). Functional outcome of the survived patients were assessed using the pelvic outcome scale by Cole et al. It is based on a 40 point scale for pain, ambulation, work and activity status, clinical examination and radiographic appearance. Three patients died and two patients were lost for follow up. In one patient the functional outcome couldn’t be assessed due to associated injury. Out of 15 remaining patients, 12 had good, 2 had fair, and 1 patient had poor outcome. CONCLUSION: Despite better understanding of the personality of the acutely injured pelvis and modern aggressive treatment modalities, the mortality rate still remains high. Early aggressive but thoughtful management of the patients with unstable pelvic injuries is essential for maximizing the immediate survival and long term functional outcome. Periodic thorough clinical and radiological assessment is mandatory to identify any occult injury. The role of team approach with various specialists cannot be over emphasized. The degree of hemodynamic instability does not correlate with type of pelvic injury. Emergent external skeletal fixation alone is not sufficient to restore hemodynamic stability in all patients who fail to improve after initial resuscitation. Acute management of unstable pelvic injuries is challenging and techniques of safe internal fixation are demanding. Constant dedication to improvement is and must be the goal of pelvic surgeons.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Surgical Management ; Unstable Pelvic Fractures.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 02:12
Last Modified: 14 Sep 2017 02:12
URI: http://repository-tnmgrmu.ac.in/id/eprint/3076

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