Complications associated with surgical treatment of pelvic ring fractures

Abstract

PURPOSE OF THE STUDY A retrospective analysis of complications associated with surgical treatment of pelvic ring fractures. MATERIAL Between 2004 and 2011 atotal of 257 patients with pelvic ring fractures, 176 men and 81 women with an average age of 36 years, were treated. The average follow-up was 53 months (range, 13 to 108 months). AO type C fractures, which were most frequent, were recorded in 67%, type B fractures in 30% and type A fractures in 3% of the patients. Displaced unstable fractures or markedly displaced type Afractures of the pelvic ring were indicated for surgery. RESULTS Three types of complications were distinguished, i.e., intra-operative, early and late. Of atotal of 40 intra-operative complications in 31 (16%) patients, the most frequent ones included malreduction in 14 patients (5%), nerve injury in 12 (5%), erroneous insertion of an implant in seven (3%) and vascular injury in six (2%) patients. Early post-operative complications requiring repeat surgery that were recorded in 15 patients (6%) were due to failure of osteosynthesis in seven patients, early wound infection in six, and haematoma which needed exploration in two patients. There were 25 late post-operative complications in 18 patients and they included fracture union with pelvic deformity in eight (3%) patients, chronic posterior pelvic pain in seven (3%), inguinal hernia through ascar in six (2%), pseudoarthrosis in three (1%)and late infection in one patient. DISCUSSION The outcome of surgery depends on the fracture type, method of management and associated injuries; the patient's age and bone quality also play arole. Risk factors for the development of complications include markedly displaced and unstable pelvic ring fractures, open fractures, complex pelvic injury and associated injuries which do not allow for immediate definitive fracture stabilisation. Not every poor outcome is due to acomplication per se or, the other way round, is exclusively related to the type of fracture. Many long-term sequelae arise from complex injuries. Because the anatomy of the pelvis is very complex, pelvic fractures are often associated with injury to the nerve structures and their management by reduction and fixation is difficult. CONCLUSIONS The characterisation and evaluation of complications associated with the management of pelvic ring fractures is problematic because it is difficult to distinguish which of them have been caused by pelvic ring fracture and associated injuries and which are due to surgical treatment. Although most complications arise from injury, the increasing role of surgery in their treatment leads to ahigher rate of iatrogenic complications most frequently resulting from an improper surgical technique, including fracture reduction and/or fixation.