Pelvic Malunion: A Systematic Review, Dichotomy of Definitions and Treatment

Abstract

Background and Objectives: Pelvic nonunion and malunion have been documented as rare complications in pelvic fractures and literature describing these topics is severely limited. Articles dedicated solely to pelvic malunion are nearly nonexistent. We conducted a literature search with the goal of providing a summary of the definition, causes, treatment strategies, and outcomes of pelvic malunion correction. Materials and Methods: An initial review of the literature was performed using the PubMed, ScienceDirect, and Cochrane Database of Systematic Reviews databases. Search terms used were “malunion” AND “pelvic” OR “pelvis”. Duplicate articles, non-English language articles without translations available and non-human subject studies were excluded. Results: Eleven original publications were found describing experiences with pelvic malunion. Seven of the articles were exclusively dedicated to the topic of pelvic fracture malunion, and only two reported on a series of patients treated for malunion with variably staged procedures. Most reports define pelvic pain as the main indication for surgical correction, along with gait disturbance, standing or sitting imbalance, and urinary or sexual dysfunction. Radiographically, vertical displacement of one to two centimeters and rotation of the hemipelvis of fifteen degrees or more have been described in defining malunion. No treatment algorithms exist, and each patient is treated with a unique work-up and operative plan due to the complexity of the problem. Only one series reported a patient satisfaction rate of 75% following malunion treatment. Conclusions: Pelvic malunion is a rare complication of pelvic ring injury and is seldom discussed in the literature. We found two small case series reporting exclusively on malunion treatment and complications. While some of the combination studies made the distinction in the diagnosis of malunion and nonunion, they rarely differentiated the treatment outcomes between the two categories. This paper describes pelvic malunion and highlights the need for more research into surgical outcomes of treatment specifically regarding functionality, patient satisfaction, and recurrence of preoperative symptoms.

Anterior peri-sacroiliac joint osteotomy in the treatment of malunion and nonunion of complex pelvic ring fracture: techniques and preliminary results

“…In past decades, multi-stage surgery was firstly reported by Matta et al and used to correct malunion and nonunion of pelvic fracture [1,10,17]. Nevertheless, this method requires changes in positions intra-operatively, with a prolonged operative duration reported as 4.6 to 8 h [8,10,18]. Simultaneously, an increased risk of posterior wound infection was observed by Rousseau et al [10].…”

“…A high incidence of disability and deformity of the lower limbs results from the malunion and nonunion of a pelvic fracture [4,5]. Due to the fracture displacement, callus formation, and soft tissue contracture, the anatomical structure cannot be distinguished in cases of pelvic fracture malunion and nonunion [6][7][8]. The surgical repair of delayed pelvic fracture is challenging for even senior surgeons, especially when the posterior ring is involved.…”

Late surgical correction after complex unstable pelvic fracture 61 C3 (OTA/AO) of an 18-year-old woman

“…2,7,11 Currently, there is a paucity of literature describing these treatment algorithms. 7,8,12 This lack of information is primarily due to the efficiency of acute care from highly resourced trauma centers and specialized pelvis surgeons. 10,13 To improve patient outcomes globally, this case report describes the principles and careful planning required to perform reconstructive osteotomies for pelvis malunion, specifically focusing on surgery within a middle-income country health care system that has some access to advanced imaging and surgical expertise.…”