OTA 2006 Posters

Scientific Poster #61 Pelvis

Posterior Approach to the Pelvic Ring: Revisited
Michael D. Stover, MD (a-Synthes); Leslie Manion, RN (*);
Loyola University Medical Center, Maywood, Illinois, USA

Purpose: Globally unstable pelvic fractures are defined by a complete disruption of the posterior pelvic ring (61C.1-3). Concerns over soft-tissue complications associated with the posterior approach have led to the development of less invasive surgical options. In 1998, 193 patients who underwent a posterior approach were retrospectively reviewed. Six patients (3%) developed deep wound infections without associated soft-tissue necrosis or skin slough. The purpose of this study is to define the use of the posterior approach and incidence of soft-tissue complications in a consecutive series of unstable injuries (61-C) treated at a single institution by a single surgeon since fellowship training.

Methods: Data on the 193 patients gathered prior to 1998 at 6 centers served as historical controls. All patients admitted to a level 1 trauma center from 1998 to 2005 with 61-C pelvic injuries were included in this study. 45 patients underwent a posterior approach, 7 had a midline approach for spinal pelvic dissociation, 10 had an anterior approach, and 15 underwent percutaneous stabilization. 28.5% of the patients had sacroiliac joint dislocations, 30% fracture dislocations, 3% transiliac fractures, and 38.5% sacral fractures.

Results: One patient had an anterior urine collection from a ruptured bladder requiring evacuation through a Pfannensteil approach; this wound grew bacteria. The posterior wound was opened, but did not have an infection. One patient had prolonged wound drainage requiring a return to the operating room for irrigation debridement (¥ 2) and closure. One wound had continued drainage that was culture-positive on debridement, required repeat debridements, removal of hardware, and healing by secondary intent (2.2 %). No patients had evidence of infection at follow-up. There were no wound or soft-tissue necroses. In 51 patients a posterior approach was planned, but the surgical approach was altered in 6 (12%) due to compromise of the posterior soft tissues.

Conclusion: With appropriate patient selection, the posterior approach remains a safe method for reduction and fixation of unstable pelvic posterior ring injuries. Alternative approaches may be indicated in the presence of associated posterior soft-tissue compromise.

Significance: Appropriate training may help to avoid some of the learning curve associated with the approach. Evaluation of the soft-tissue envelope allows for its appropriate use in the majority of unstable posterior injuries.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.