A follow-up after 2 years on average could be done in 43 cases of pelvic ring injuries. Seven were type A, 8 type B and 28 type C lesions. Every type A lesion was treated non-operatively. External fixation and non-operative management were used with type B injuries. As well as non-operative treatment, both internal and external surgical techniques were employed for type C fractures. While group A hardly mentioned pain in the follow-up, groups B and C suffered dorsal pelvic pain of comparable intensity irrespective of the therapeutic measures taken. Anatomic reduction does not guarantee freedom from pain. We also rated hip joint flexibility and ability to walk according to the Merle D'Aubigné score. Because of their pelvic injuries 50% of the type C patients changed their profession. The sequelae of the accident on sports and leisure time activities will be considered as well as the subjective contentment evaluated. Unstable and dislocated pelvic ring injuries permanently interfere to a high degree with the quality of life. It is remarkable that many of the traumatic lesions which interfere with the quality of life are caused by the traumatic violence itself and cannot be influenced by the manner of surgical stabilization.

Based on CT criterias, in most patients a statement concerning the applied forces, the stability of the pelvic rim and the fracture type can be made.

Zusammenfassung: Die vorliegende Studie untersucht die Auftretensrate der Posttraumatischen Belastungsstörung (PTSD) drei bis vier Monate nach einem Verkehrsunfall sowie ihre Vorhersagbarkeit durch eine frühzeitige Datenerhebung. Untersucht wurde der Einfluss einer akuten PTSD-Symptomatik kurz nach dem Unfall sowie Risikofaktoren, die aus einschlägigen Theorien abgeleitet wurden. Dazu wurden 48 Verkehrsunfallopfer, die Patienten auf unfallchirurgischen Stationen waren, durchschnittlich elf Tage nach dem Unfall zu ihrer Soziobiografie und zum Unfallhergang befragt. Zum gleichen Zeitpunkt sowie dreieinhalb Monate nach dem Unfall wurde mit dem SKID-PTSD diagnostiziert, ob eine PTSD-Symptomatik vorliegt. Im Untersuchungsdesign fanden empirische sowie methodische Kontrollen für die Untersuchung psychotraumatischer Auswirkungen durch physische Verletzung Berücksichtigung. Die Auftretensrate betrug 18.8 % für eine voll ausgeprägte und 14.6 % für eine subsyndromale PTSD. Als Risikofaktoren für deren Entstehen konnten das weibliche Geschlecht, eine hohe materielle Verlusteinschätzung, das Vorhandensein einer posttraumatischen Akutsymptomatik sowie Variablen des Erholungsverlaufs hervorgehoben werden. Eine logistische Regression ergab, dass eine PTSD-Symptomatik zu 75 % korrekt mit diesen Variablen vorhergesagt werden kann. Die Relevanz der Ergebnisse für künftige Studien wird diskutiert.

48 injuries to the pelvis were treated from January 1991 through December 1991. We found 45 fractures of the pelvic ring with associated acetabular fractures in 15 cases and three isolated acetabular lesions. 19 injuries were caused by car accidents, 18 fractures resulted from a fall, especially in older patients. Isolated fractures of the pelvis occurred in 18 cases. The average total severity of the injuries was 19.7 points according to the Hannover Polytrauma Score (PTS). Every fracture was classified using the Tile-classification. There were 15 (33%) Tile A lesions, 18 (40%) Tile B fractures and twelve (27%) type C pelvic ring injuries. In 18 cases surgery was the method of treatment. Seven out of 18 injuries to the acetabulum were treated with open reduction and internal fixation. In ten patients the unstable pelvic ring was fixed by means of an external fixator. To do so, a pair of 6 mm diameter pins were placed on both sides in the supraacetabular region of the iliac bone directed towards the sacroiliac joints. We used a triangular form of external fixation. An open reduction and internal fixation (ORIF) was necessary in five cases, one injury required a combination of external and internal procedures. There were 14 cases in which we found sacral fractures as an additional dorsal lesion. Nine of 14 sacral fractures were recognized only by CT examination. In eleven cases the conventional radiographs showed simple anterior pelvic ring fractures while the CT examination revealed an additional lesion of the sacroiliac joint in nine of these cases.(ABSTRACT TRUNCATED AT 250 WORDS)

No abstract