The pelvic fractures are uncommon skeletal injuries and require a high energy traumatic forces to occur. An organized regular system of evaluation of these patients must start from the moment of hospital arrive. The definitive treatment of displaced pelvic ring fractures should be wisely decided by an experienced surgeon after careful evaluation of the patient generally and of his type of fracture (Tornetta and Templeman, 2005).
It is the degree of instability of the pelvic ring; not only the degree of initial displacement, that decides the definitive treatment. Partially stable injuries are generally managed conservatively; but with few exceptions. Unstable injuries must be reduced anatomically; if possible, and fixed internally. The posterior pelvic lesion must be fixed and the anterior lesion should be fixed in indicated cases (Matta and Tornetta., 1996) (Tornetta and Templeman2005).
Reduction of the posterior lesion displacement to less than 10 mm of displacement may not affect the final functional result (Matta and Tornetta 1996).
The severly displaced pelvic ring fractures result from a very high energy traumatic forces and are usually associated with neurological, genitourinary, vascular, gastrointestinal, soft tissues or other skeletal injuries. The presence of associated injuries especially neurological can significantly affect the functional outcome of the patients (Cole et al., 1996), (Miranda et al., 1996). (Tile, 2003).
There are variable techniques and implants for fixation of the posterior pelvic lesion each has its advantages and drawbacks. Whenever possible; fixation of the posterior pelvic lesion with the patients supine (by plating of the SI joint anteriorly or percutaneous iliosacral screw fixation for SI dislocation or sacral fracture) is much better than using the posterior approach with the patient prone (Shuler et al., 1995), (Routt and Simonian, 1996), (Leighton and Waddell, 1996).
From August 2002 till July 2005 we managed 30 case with displaced pelvic fractures. The protocol for treatment was planned individually for each case according to the type of pelvic fracture. Definitive treatment was dependant on the stability and the degree of displacement. The partially stable injuries with little displacement were definitively managed conservatively while the unstable injuries and those partially stable injuries with marked displacement were definitively managed by open reduction and internal fixation.
Although ORIF of displaced unstable pelvic fractures is a techniqually demanding procedure, it is strongly recommended to restore pelvic stability, correct leg length inequality and pelvic deformity and allows early mobilization of the patient from bed.
Although we did not use the percutaneous technique for fixation of the posterior pelvic injuries, we strongly recommend this technique to be used in the suitable cases because it is rapid, avoids the complications of surgical approaches especially the posterior ones, and it allows for early patient mobilization.
Our small number of cases, short periods of follow up and the variable treatment methods did not help to obtain a statistically significant results of the definitive treatment of displaced pelvic ring fractures.
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