Postoperative Reduction Quality May Be the Most Important Factor That Causes Worse Functional Outcomes in Open and Closed Pelvic Fractures

Abstract

Background Data on the functional outcomes of patients with open pelvic fractures after osteosynthesis are limited, and whether open fracture is a risk factor for worse outcomes, as compared with closed fracture, remains unclear. This study aimed to compare the functional outcomes of patients with open and closed pelvic fractures and evaluate potential factors that might affect outcomes. Methods Overall, 19 consecutive patients with open pelvic fractures and 78 patients with closed pelvic fractures between January 2014 and June 2018 were retrospectively reviewed. All fractures were surgically treated, with a minimal follow-up period of three years. Patients’ demographic profile, associated injuries, management protocol, quality of reduction, and outcomes were recorded and analyzed. Results Patients with open pelvic fractures had higher new injury severity score, higher incidence of diverting colostomy, and longer length of stay. Both radiological and functional evaluations revealed no significant differences between the two groups at 1-year and 3-year evaluations. Multiple logistic regression analysis identified poor radiological outcomes (using Lefaivre criteria) and longer length of stay as risk factors for worse short-term functional outcomes. At 3-year evaluation, fair-to-poor radiological outcomes (using Matta/Tornetta and Lefaivre criteria) and the presence of diverting colostomy were potential risk factors. Conclusions Compared with closed pelvic fracture, open pelvic fracture was not an indicator of worse functional outcomes. Functional outcomes may be comparable between patients with open and closed pelvic fractures at different time points within three years postoperatively. Achieving anatomical reduction in a fracture is crucial, because it might affect patient satisfaction.

Surgical management of acetabular fractures associated with pelvic ring disruption, the time-dependent effect of delay

“…Noncontrollable factors include age, fracture pattern, associated chondral damage, and patient medical condition while controllable factors include timing of surgery and complications. 14,15 Delay in the definitive intervention of these injuries results in an increase in the formation of scar tissue between bony fragments and the formation of a soft callus at the fracture site. This will result in a more difficult exposure and a more difficult reduction of fracture fragments.…”

“…This will result in a more difficult exposure and a more difficult reduction of fracture fragments. 13,15 Delay in fixation may also be detrimental to the viability of the femoral head in cases of persistent subluxation or dislocation increasing the incidence of both chondrolysis and osteonecrosis of the head. 13 In our thesis, the time elapsed from the date of trauma to the operation ranged from 0 days to 21 days.…”

“…The quality of reduction is the major determinant factor of the clinical outcome and in turn, the quality of reduction is affected by non-controllable and controllable factors. Noncontrollable factors include age, fracture pattern, associated chondral damage, and patient medical condition while controllable factors include timing of surgery and complications 14,15 …”

TiRobot‑assisted versus conventional fluoroscopy-assisted percutaneous sacroiliac screw fixation for pelvic ring injuries: a meta‑analysis

“…Screw positioning, evaluated by Florian Gras classification, was notably improved in the TiRobot group in our meta-analysis. Reduction is a crucial step in the surgical treatment of bone fractures to achieve anatomical alignment and facilitate healing [ 37 , 38 ]. The Matta score evaluates the reduction quality of pelvic fractures [ 38 ].…”

“…Reduction is a crucial step in the surgical treatment of bone fractures to achieve anatomical alignment and facilitate healing [ 37 , 38 ]. The Matta score evaluates the reduction quality of pelvic fractures [ 38 ]. Our meta-analysis found no significant difference between overall excellent and good rate of reduction accuracy according to Matta criteria.…”