Skip to main content
Erschienen in: International Orthopaedics 2/2009

01.04.2009 | Review

Pelvic ring disruptions: treatment modalities and analysis of outcomes

verfasst von: C. Papakostidis, N. K. Kanakaris, G. Kontakis, P. V. Giannoudis

Erschienen in: International Orthopaedics | Ausgabe 2/2009

Einloggen, um Zugang zu erhalten

Abstract

A systematic review of the English literature over the last 30 years was conducted in order to investigate the correlation of the clinical outcome of different types of pelvic ring injuries to the method of treatment. Three basic therapeutic approaches were analysed: non-operative treatment (group A), stabilisation of anterior pelvis (group B) and internal fixation of posterior pelvis (group C). Of 818 retrieved reports, 27 case series, with 28 groups of patients and 1,641 patients, met our inclusion criteria. The quality of the literature was evaluated using a structured questionnaire. Outcomes of the eligible studies were summarised by the medians of the reported results. Most of the component studies were of fair or poor quality. Certain radiological results (quality of reduction, malunion rates) were significantly better in group C. From the functional point of view only walking capacity was proved to be significantly better in the groups of operative treatment compared to the non-operative group.
Literatur
1.
Zurück zum Zitat Berg EE, Chebuhar C, Bell RM (1996) Pelvic trauma imaging: a blinded comparison of computed tomography and roentgenograms. J Trauma 41:994–998PubMedCrossRef Berg EE, Chebuhar C, Bell RM (1996) Pelvic trauma imaging: a blinded comparison of computed tomography and roentgenograms. J Trauma 41:994–998PubMedCrossRef
2.
Zurück zum Zitat Broos P, Vanderschot P, Craninx L, Rommens P (1992) The operative treatment of unstable pelvic ring fractures. Int Surg 77:303–308PubMed Broos P, Vanderschot P, Craninx L, Rommens P (1992) The operative treatment of unstable pelvic ring fractures. Int Surg 77:303–308PubMed
3.
Zurück zum Zitat Browner BD, Cole JD, Graham JM et al (1987) Delayed posterior internal fixation of unstable pelvic fractures. J Trauma 27:998–1006PubMedCrossRef Browner BD, Cole JD, Graham JM et al (1987) Delayed posterior internal fixation of unstable pelvic fractures. J Trauma 27:998–1006PubMedCrossRef
4.
Zurück zum Zitat Bucholz RW (1981) The pathological anatomy of Malgaigne fracture-dislocations of the pelvis. J Bone Joint Surg Am 63:400–404PubMed Bucholz RW (1981) The pathological anatomy of Malgaigne fracture-dislocations of the pelvis. J Bone Joint Surg Am 63:400–404PubMed
5.
Zurück zum Zitat Cole JD, Blum DA, Ansel LJ (1996) Outcome after fixation of unstable posterior pelvic ring injuries. Clin Orthop Relat Res 329:160-179PubMedCrossRef Cole JD, Blum DA, Ansel LJ (1996) Outcome after fixation of unstable posterior pelvic ring injuries. Clin Orthop Relat Res 329:160-179PubMedCrossRef
6.
Zurück zum Zitat Dujardin FH, Hossenbaccus M, Duparc F et al (1998) Long-term functional prognosis of posterior injuries in high-energy pelvic disruption. J Orthop Trauma 12:145–150 discussion 50-51PubMedCrossRef Dujardin FH, Hossenbaccus M, Duparc F et al (1998) Long-term functional prognosis of posterior injuries in high-energy pelvic disruption. J Orthop Trauma 12:145–150 discussion 50-51PubMedCrossRef
7.
Zurück zum Zitat Gansslen A, Pohlemann T, Paul C et al (1996) Epidemiology of pelvic ring injuries. Injury 27(Suppl 1):S-A13–S-A20 Gansslen A, Pohlemann T, Paul C et al (1996) Epidemiology of pelvic ring injuries. Injury 27(Suppl 1):S-A13–S-A20
8.
Zurück zum Zitat Goldstein A, Phillips T, Sclafani SJ et al (1986) Early open reduction and internal fixation of the disrupted pelvic ring. J Trauma 26:325–333PubMedCrossRef Goldstein A, Phillips T, Sclafani SJ et al (1986) Early open reduction and internal fixation of the disrupted pelvic ring. J Trauma 26:325–333PubMedCrossRef
9.
Zurück zum Zitat Gruen GS, Leit ME, Gruen RJ et al (1995) Functional outcome of patients with unstable pelvic ring fractures stabilized with open reduction and internal fixation. J Trauma 39:838–844 discussion 44-45PubMedCrossRef Gruen GS, Leit ME, Gruen RJ et al (1995) Functional outcome of patients with unstable pelvic ring fractures stabilized with open reduction and internal fixation. J Trauma 39:838–844 discussion 44-45PubMedCrossRef
10.
Zurück zum Zitat Henderson RC (1989) The long-term results of nonoperatively treated major pelvic disruptions. J Orthop Trauma 3:41–47PubMedCrossRef Henderson RC (1989) The long-term results of nonoperatively treated major pelvic disruptions. J Orthop Trauma 3:41–47PubMedCrossRef
11.
Zurück zum Zitat Hirvensalo E, Lindahl J, Bostman O (1993) A new approach to the internal fixation of unstable pelvic fractures. Clin Orthop Relat Res 297:28-32PubMed Hirvensalo E, Lindahl J, Bostman O (1993) A new approach to the internal fixation of unstable pelvic fractures. Clin Orthop Relat Res 297:28-32PubMed
12.
Zurück zum Zitat Kabak S, Halici M, Tuncel M et al (2003) Functional outcome of open reduction and internal fixation for completely unstable pelvic ring fractures (type C): a report of 40 cases. J Orthop Trauma 17:555–562PubMedCrossRef Kabak S, Halici M, Tuncel M et al (2003) Functional outcome of open reduction and internal fixation for completely unstable pelvic ring fractures (type C): a report of 40 cases. J Orthop Trauma 17:555–562PubMedCrossRef
13.
Zurück zum Zitat Keating JF, Werier J, Blachut P et al (1999) Early fixation of the vertically unstable pelvis: the role of iliosacral screw fixation of the posterior lesion. J Orthop Trauma 13:107–113PubMedCrossRef Keating JF, Werier J, Blachut P et al (1999) Early fixation of the vertically unstable pelvis: the role of iliosacral screw fixation of the posterior lesion. J Orthop Trauma 13:107–113PubMedCrossRef
14.
Zurück zum Zitat Korovessis P, Baikousis A, Stamatakis M, Katonis P (2000) Medium- and long-term results of open reduction and internal fixation for unstable pelvic ring fractures. Orthopedics 23:1165–1171PubMed Korovessis P, Baikousis A, Stamatakis M, Katonis P (2000) Medium- and long-term results of open reduction and internal fixation for unstable pelvic ring fractures. Orthopedics 23:1165–1171PubMed
15.
Zurück zum Zitat Lansinger O, Karlsson J, Berg U, Mare K (1984) Unstable fractures of the pelvis treated with a trapezoid compression frame. Acta Orthop Scand 55:325–329PubMedCrossRef Lansinger O, Karlsson J, Berg U, Mare K (1984) Unstable fractures of the pelvis treated with a trapezoid compression frame. Acta Orthop Scand 55:325–329PubMedCrossRef
16.
Zurück zum Zitat Leung KS, Chien P, Shen WY, So WS (1992) Operative treatment of unstable pelvic fractures. Injury 23:31–37PubMedCrossRef Leung KS, Chien P, Shen WY, So WS (1992) Operative treatment of unstable pelvic fractures. Injury 23:31–37PubMedCrossRef
17.
Zurück zum Zitat Lindahl J, Hirvensalo E (2005) Outcome of operatively treated type-C injuries of the pelvic ring. Acta Orthop 76:667–678PubMedCrossRef Lindahl J, Hirvensalo E (2005) Outcome of operatively treated type-C injuries of the pelvic ring. Acta Orthop 76:667–678PubMedCrossRef
18.
Zurück zum Zitat Lindahl J, Hirvensalo E, Bostman O, Santavirta S (1999) Failure of reduction with an external fixator in the management of injuries of the pelvic ring. Long-term evaluation of 110 patients. J Bone Joint Surg Br 81:955–962PubMedCrossRef Lindahl J, Hirvensalo E, Bostman O, Santavirta S (1999) Failure of reduction with an external fixator in the management of injuries of the pelvic ring. Long-term evaluation of 110 patients. J Bone Joint Surg Br 81:955–962PubMedCrossRef
19.
Zurück zum Zitat Majeed SA (1990) External fixation of the injured pelvis. The functional outcome. J Bone Joint Surg Br 72:612–614PubMed Majeed SA (1990) External fixation of the injured pelvis. The functional outcome. J Bone Joint Surg Br 72:612–614PubMed
20.
Zurück zum Zitat Majeed SA (1989) Grading the outcome of pelvic fractures. J Bone Joint Surg Br 71:304–306PubMed Majeed SA (1989) Grading the outcome of pelvic fractures. J Bone Joint Surg Br 71:304–306PubMed
21.
Zurück zum Zitat Matewski D, Szymkowiak E, Bilinski P (2007) Analysis of management of patients with multiple injuries of the locomotor system. Int Orthop Jul 3 [Epub ahead of print] Matewski D, Szymkowiak E, Bilinski P (2007) Analysis of management of patients with multiple injuries of the locomotor system. Int Orthop Jul 3 [Epub ahead of print]
22.
Zurück zum Zitat Matta JM, Saucedo T (1989) Internal fixation of pelvic ring fractures. Clin Orthop Relat Res 242:83-97PubMed Matta JM, Saucedo T (1989) Internal fixation of pelvic ring fractures. Clin Orthop Relat Res 242:83-97PubMed
23.
Zurück zum Zitat Matta JM, Tornetta P 3rd (1996) Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res 329:129-140PubMedCrossRef Matta JM, Tornetta P 3rd (1996) Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res 329:129-140PubMedCrossRef
24.
Zurück zum Zitat McLaren AC, Rorabeck CH, Halpenny J (1990) Long-term pain and disability in relation to residual deformity after displaced pelvic ring fractures. Can J Surg 33:492–494PubMed McLaren AC, Rorabeck CH, Halpenny J (1990) Long-term pain and disability in relation to residual deformity after displaced pelvic ring fractures. Can J Surg 33:492–494PubMed
25.
Zurück zum Zitat Miranda MA, Riemer BL, Butterfield SL, Burke CJ 3rd (1996) Pelvic ring injuries. A long term functional outcome study. Clin Orthop Relat Res 329:152-159PubMedCrossRef Miranda MA, Riemer BL, Butterfield SL, Burke CJ 3rd (1996) Pelvic ring injuries. A long term functional outcome study. Clin Orthop Relat Res 329:152-159PubMedCrossRef
26.
Zurück zum Zitat Monahan PR, Taylor RG (1975) Dislocation and fracture-dislocation of the pelvis. Injury 6:325–333PubMedCrossRef Monahan PR, Taylor RG (1975) Dislocation and fracture-dislocation of the pelvis. Injury 6:325–333PubMedCrossRef
27.
Zurück zum Zitat Nepola JV, Trenhaile SW, Miranda MA et al (1999) Vertical shear injuries: is there a relationship between residual displacement and functional outcome? J Trauma 46:1024–1029 discussion 9-30PubMedCrossRef Nepola JV, Trenhaile SW, Miranda MA et al (1999) Vertical shear injuries: is there a relationship between residual displacement and functional outcome? J Trauma 46:1024–1029 discussion 9-30PubMedCrossRef
28.
Zurück zum Zitat Oliver CW, Twaddle B, Agel J, Routt ML Jr (1996) Outcome after pelvic ring fractures: evaluation using the medical outcomes short form SF-36. Injury 27:635–641PubMedCrossRef Oliver CW, Twaddle B, Agel J, Routt ML Jr (1996) Outcome after pelvic ring fractures: evaluation using the medical outcomes short form SF-36. Injury 27:635–641PubMedCrossRef
29.
Zurück zum Zitat Papadopoulos IN, Kanakaris N, Bonovas S et al (2006) Auditing 655 fatalities with pelvic fractures by autopsy as a basis to evaluate trauma care. J Am Coll Surg 203:30–43PubMedCrossRef Papadopoulos IN, Kanakaris N, Bonovas S et al (2006) Auditing 655 fatalities with pelvic fractures by autopsy as a basis to evaluate trauma care. J Am Coll Surg 203:30–43PubMedCrossRef
30.
Zurück zum Zitat Pennal GF, Tile M, Waddell JP, Garside H (1980) Pelvic disruption: assessment and classification. Clin Orthop Relat Res 151:12-21PubMed Pennal GF, Tile M, Waddell JP, Garside H (1980) Pelvic disruption: assessment and classification. Clin Orthop Relat Res 151:12-21PubMed
31.
Zurück zum Zitat Pohlemann T, Bosch U, Gansslen A, Tscherne H (1994) The Hannover experience in management of pelvic fractures. Clin Orthop Relat Res 305:69-80PubMedCrossRef Pohlemann T, Bosch U, Gansslen A, Tscherne H (1994) The Hannover experience in management of pelvic fractures. Clin Orthop Relat Res 305:69-80PubMedCrossRef
32.
Zurück zum Zitat Poole GV, Ward EF, Muakkassa FF et al (1991) Pelvic fracture from major blunt trauma. Outcome is determined by associated injuries. Ann Surg 213:532–538 discussion 8-9PubMed Poole GV, Ward EF, Muakkassa FF et al (1991) Pelvic fracture from major blunt trauma. Outcome is determined by associated injuries. Ann Surg 213:532–538 discussion 8-9PubMed
33.
Zurück zum Zitat Ragnarsson B, Olerud C, Olerud S (1993) Anterior square-plate fixation of sacroiliac disruption. 2-8 years follow-up of 23 consecutive cases. Acta Orthop Scand 64:138–142PubMed Ragnarsson B, Olerud C, Olerud S (1993) Anterior square-plate fixation of sacroiliac disruption. 2-8 years follow-up of 23 consecutive cases. Acta Orthop Scand 64:138–142PubMed
34.
Zurück zum Zitat Riska EB, von Bonsdorff H, Hakkinen S et al (1979) External fixation of unstable pelvic fractures. Int Orthop 3:183–188PubMedCrossRef Riska EB, von Bonsdorff H, Hakkinen S et al (1979) External fixation of unstable pelvic fractures. Int Orthop 3:183–188PubMedCrossRef
35.
Zurück zum Zitat Semba RT, Yasukawa K, Gustilo RB (1983) Critical analysis of results of 53 Malgaigne fractures of the pelvis. J Trauma 23:535–537PubMedCrossRef Semba RT, Yasukawa K, Gustilo RB (1983) Critical analysis of results of 53 Malgaigne fractures of the pelvis. J Trauma 23:535–537PubMedCrossRef
36.
Zurück zum Zitat Simonian PT, Routt ML Jr (1997) Biomechanics of pelvic fixation. Orthop Clin North Am 28:351–367PubMedCrossRef Simonian PT, Routt ML Jr (1997) Biomechanics of pelvic fixation. Orthop Clin North Am 28:351–367PubMedCrossRef
37.
Zurück zum Zitat Slatis P, Karaharju EO (1980) External fixation of unstable pelvic fractures: experiences in 22 patients treated with a trapezoid compression frame. Clin Orthop Relat Res 151:73-80PubMed Slatis P, Karaharju EO (1980) External fixation of unstable pelvic fractures: experiences in 22 patients treated with a trapezoid compression frame. Clin Orthop Relat Res 151:73-80PubMed
38.
Zurück zum Zitat Taguchi T, Kawai S, Kaneko K, Yugue D (2000) Surgical treatment of old pelvic fractures. Int Orthop 24:28–32PubMedCrossRef Taguchi T, Kawai S, Kaneko K, Yugue D (2000) Surgical treatment of old pelvic fractures. Int Orthop 24:28–32PubMedCrossRef
39.
Zurück zum Zitat Tile M (1995) Classification. In: Tile M (ed) Fractures of the pelvis and acetabulum. Williams and Wilkins, Baltimore, pp 66-101 Tile M (1995) Classification. In: Tile M (ed) Fractures of the pelvis and acetabulum. Williams and Wilkins, Baltimore, pp 66-101
40.
Zurück zum Zitat Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 70:1-12PubMed Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 70:1-12PubMed
41.
Zurück zum Zitat Tornetta P 3rd, Matta JM (1996) Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res 329:186-193PubMedCrossRef Tornetta P 3rd, Matta JM (1996) Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res 329:186-193PubMedCrossRef
42.
Zurück zum Zitat Van den Bosch EW, Van der Kleyn R, Hogervorst M, Van Vugt AB (1999) Functional outcome of internal fixation for pelvic ring fractures. J Trauma 47:365–371PubMedCrossRef Van den Bosch EW, Van der Kleyn R, Hogervorst M, Van Vugt AB (1999) Functional outcome of internal fixation for pelvic ring fractures. J Trauma 47:365–371PubMedCrossRef
43.
Zurück zum Zitat Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483PubMedCrossRef Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483PubMedCrossRef
44.
Zurück zum Zitat Wild JJ, Hanson GW, Tullos HS (1982) Unstable fractures of the pelvis treated by external fixation. J Bone Joint Surg Am 64:1010–1020PubMed Wild JJ, Hanson GW, Tullos HS (1982) Unstable fractures of the pelvis treated by external fixation. J Bone Joint Surg Am 64:1010–1020PubMed
Metadaten
Titel
Pelvic ring disruptions: treatment modalities and analysis of outcomes
verfasst von
C. Papakostidis
N. K. Kanakaris
G. Kontakis
P. V. Giannoudis
Publikationsdatum
01.04.2009
Verlag
Springer-Verlag
Erschienen in
International Orthopaedics / Ausgabe 2/2009
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-008-0555-6

Weitere Artikel der Ausgabe 2/2009

International Orthopaedics 2/2009 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.