The Outcome of Internal Fixation by Anterior Pelvic Plating & Posterior Percutaneous Iliosacral Screw in Tile Type-C Pelvic Ring Fracture

Abstract

Background: Pelvic fractures constitute one of the most severe orthopaedic injuries causing significant mortality & morbidity. Unstable pelvic ring disruptions result from high-energy trauma and are associated with multiple concomitant injuries. Many patients suffered from complications like prolonged hospital stay & immobilization, mal-union, chronic pain, limb length discrepancies, sitting problem & impaired gait due to inadequate treatment. Effective emergency medical services & proper definitive management must be ensured to save lives & reduce long-term complications.  Objectives: To evaluate the outcome of internal fixation by anterior pelvic plating & posterior percutaneous iliosacral screw in tile Type-C pelvic ring fracture.  Materials and Methods: This prospective interventional study was conducted at the Department of Orthopaedic Surgery, Dhaka Medical College & Hospital, Dhaka, for two years from July 2019 to June 2021. Patients of diagnosed Tile Type-C pelvic ring fractures were the study population. A total of 22 patients aged (18 to 60) years presenting within three weeks of injury were included in the study. Radiological & functional outcomes were evaluated six months after surgery according to Matta radiographic criteria and Majeed score, respectively. Data included demography of the patients, mechanism of injuries, associated injuries, emergency interventions, fracture types, post-operative complications & length of hospital stay.  Results: In this study, the highest number of patients, 08(36.36%), was observed in the third decade, and the lowest number, 01(4.55%), was observed in the second decade. The mean age was 37.82±14.82, ranging from 18 to 60 years. The majority of the patients are male workers. According to Matta radiographic criteria, 6 months after surgery 11(50%) patients had excellent, 8(36.36%) patients had good, 3(13.64%) had fair radiological outcome. According to Majeed score grading, the overall functional outcome of the study population revealed that 18 patients (81.82%) belonged to good (excellent + good), and four patients (18.18%) belonged to unsatisfactory (poor + fair) outcomes. Only 02 patients (9.09%) patients had wound infection, 02 patients (9.09%) had erectile dysfunction, 02 patients (9.09%) had urinary tract infection, 01 patient (4.55%) had implant loosening & 14 patients (63.63%) patients had no post-operative complications.  Conclusion: It is concluded that internal fixation of Tile type – C pelvic ring fractures by anterior pelvic plating and posterior per-cutaneous iliosacral screw are a satisfactory and effective management method for early mobilization and rehabilitation of the patients.