[Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group]

Abstract

Pelvic fractures are rare injuries (3-8%) when compared to fractures in other body regions. They are accompanied by high mortality (5-20%), and the survivors suffer from severe pain and pelvic-related handicaps. The German Pelvic Group (German Chapter of the AO-International & German Trauma Society) started a prospective multicenter study, including ten major trauma centers for collecting a high number of data in a short period of time (1991-1993). All pelvic injuries were documented consecutively using a special set of evaluation sheets. The study closed with 1,722 patients. A 2-year follow-up was completed for 486 patients injured in 1991 and 1992 after type B and C injuries, complex pelvic trauma, acetabulum fractures and a random 25% of A-type injuries (overall follow-up rate 73%). The follow-up included special "out-come" criteria. Of the pelvic ring injuries without significant peripelvic soft tissue involvement, 63.6% were A-type fractures, 21.0% B-type injuries and 15.5% C-type injuries. The rate of operative stabilization was 3.9% after A-type injuries, 37.3% after B-type injuries and 54.3% after C-type injuries. In isolated acetabular fractures ORIF was performed in 38.6%. The total lethality was 7.9% with a significant difference between "complex" pelvic trauma (21.3%) and patients without concomitant peripelvic injuries (7.2%). In 0.9% the pelvic injury was reported as the main cause of death. Pain at follow-up was observed in every classification group, the rate of completely "pain-free" patients being 55% after A-type, 41% after B-type and 27% after C-type fractures. Malfunction of micturia was reported by 7.6% of all patients, sexual malfunction by 11.6% of the males ("erectile dysfunction") and 2.2% of the female ("dysparneuria"). Scaled by the recently developed "outcome score", the radiological result showed anatomical healing after 90.8% of the B-type and 74.6% of the C-type injuries. On the other hand, the clinical result was rated as good or excellent in only 70% of the B-type and 54% of the C-type injuries. Although progress in indications and treatment techniques has shown improved radiological results after unstable pelvic ring injuries when compared to earlier studies, the clinical result still remains unsatisfactory. Further analyses and studies must be conducted to identify the prognostic factors for the late sequelae. Whether it is possible influence these factors by additional surgical intervention cannot be answered at present.