OPERATIVE FIXATION OF SEVERE PELVIC RING FRACTURES: A 30-YEAR REVIEW DETAILING ORTHOPAEDIC AND NON-ORTHOPAEDIC SEQUELAE
Bibliographic record
Abstract
Chronic pelvic instability (pelvic floor injury) can lead to debilitating pain and deformity, sexual dysfunction, and bowel and bladder impairment. The purpose of this study is to review the outcomes of major pelvic ring fractures over the past 20 years to quantify the early and in particular the heretofore poorly documented late outcomes and complications after operative fixation in both males and females. Healing of the pelvic ring is the primary outcome but secondary outcomes include: deep vein thrombosis, pulmonary emboli, low back pain, urinary function, sexual function, lower extremity neurological injuries and the presence of abdominal hernias as they are all important aspects of successful long-term outcome Acute and delayed fixation were included for fractures with vertical, rotational, and combined instability. This includes fractures and fracture dislocations of the sacroiliac (SI) joint and pelvic ring injuries using the Young/Burgess classification system. Patients with Anterior Posterior I (APC I) or Lateral Compression I (LC I) injuries were excluded. All APC II, III, and LC II and III along with vertical shear as well as combined mechanism injuries were included. Complications of interest included sacro-iliac (SI) joint pain, lower back pain, urological symptoms (male and female), distal lower extremity neurological injury, sexual dysfunction (male and female), deep vein thrombosis (DVT), pulmonary embolism (PE), malunion, and non-union. Acute and delayed fixation were included for fractures with vertical, rotational, and combined instability. This includes fractures and fracture dislocations of the sacroiliac (SI) joint and pelvic ring injuries using the Young/Burgess classification system. Patients with Anterior Posterior I (APC I) or Lateral Compression I (LC I) injuries were excluded. All APC II, III, and LC II and III along with vertical shear as well as combined mechanism injuries were included. Complications of interest included sacro-iliac (SI) joint pain, lower back pain, urological symptoms (male and female), distal lower extremity neurological injury, sexual dysfunction (male and female), deep vein thrombosis (DVT), pulmonary embolism (PE), malunion, and non-union. Operative fixation consisted of two percutaneous sacroiliac screws inserted into either the S1 or S2 body. Trans-sacral screws were also utilized in the last 10 years of the study This was augmented by anterior pelvic fixation utilizing anterior plates or pubic rami screws. An external fixator was also used as an adjunctive anterior stability to posterior internal fixation as determined by the instability of the fracture pattern and the surgeon preference. In total there were 41 secondary operations, with 95% of these occurring in compound fractures. Eight of the compound fractures accounted for 17 of the repeat operations. Despite good prophylaxis there were 41 (18%) significant proximal DVTs and one fatal PE. Twenty-six IVC filters were inserted. Eight were left in permanently: five were permanent filters inserted early in the series prior to removable filters, while in three cases the patient was too sick to remove them early and it was felt they would cause more harm than good, with late removal. Dyspareunia occurred in 15 % of the female patients, with the incidence increased in LC III, vertical shear, and combined injuries. Urinary incontinence occurred in 22 % of females over the first two years post injury. Open reduction and internal fixation of the pelvic ring is a very safe and reliable procedure. More importantly, we can define early and late expected complications that can be anticipated in this group of patients and hopefully allow for earlier consultation with appropriate subspecialties to allow earlier help and control of these known issues in males and females. Urology, gynecology, neurology and spine subspecialists should all be relatively early consultants in these massively injured patients and can lead to improved outcomes and reduced long term pain in this subset of patients
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".