Isolated pelvic ring injuries: functional outcomes following percutaneous, posterior fixation

Abstract

Objectives: To characterize pelvic-specific functional outcomes in patients with isolated, partially unstable (AO/OTA 61-B), pelvic ring injuries treated with posterior only percutaneous screw fixation of the pelvic ring.

Patients and methods: Between September 2007 and October 2011, 16 subjects (mean age 42.4 years; range 18-90 years) with isolated, partially unstable pelvic ring injuries (AO/OTA 61-B) were treated with percutaneous, posterior pelvic ring fixation. Subjects underwent an evaluation of pelvic ring function with a modification of Majeed's pelvic functional outcome assessment tool. Subjects were excluded if they sustained a concomitant long-bone fracture, visceral injury requiring surgery, spinal cord injury, and an injury to the anterior pelvic ring or acetabulum requiring additional fixation.

Result: Mean follow-up was 30.8 (range 14-55) months. Eleven subjects sustained unilateral posterior ring injuries, and five subjects sustained bilateral posterior ring injuries. All fractures healed uneventfully, and no hardware failures were noted. Average pelvic functional outcome score at final follow-up was 85.3 % (good). All but subjects required assistive walking devices and gait and sitting comfort scored "excellent." High rates of sexual dysfunction and persistent difficulty with daily activities were noted in this series.

Conclusions: This series demonstrates that activity-specific dysfunction persists years after definitive percutaneous posterior fixation of isolated pelvic ring injuries. Radiographic outcomes were excellent as were subjects' ability to ambulate independently and sit comfortably without pain. Many complained of persistent discomfort with both daily activities and sexual activity, suggesting persistent pathology to the non-osseous structures about the pelvis.