title: Functional outcome of open reduction and internal fixation for completely unstable pelvic ring fractures (type C): a report of 40 cases.
abstract: OBJECTIVE
  To evaluate functional outcomes, morbidity and mortality rates, and psychological and psychosomatic status in patients treated for completely unstable pelvic injuries (Tile class C).
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Forty patients treated with anterior and posterior internal fixation for unstable pelvic ring fractures between January 1992 and August 1999.
  
  
  METHODS
  Open reduction and anterior and posterior internal fixation of the pelvic ring.
  
  
  METHODS
  The data were analyzed as follows: pelvic fracture classification, Tile classification; severity of trauma, Injury Severity Score (ISS); functional outcomes, the Majeed Outcome Scale; psychological and psychosomatic status, Hamilton Depression and Anxiety Rating Score (HDARS).
  
  
  RESULTS
  Preoperatively the average ISS was 29.4 (range 12-66). There was a statistically significant positive correlation between anxiety and ISS (r = 0.536, P < 0.01). Two patients died during the early postoperative period. Two additional patients were lost to follow-up, leaving 36 patients followed for an average of 45 months (range 21-116 months). Deep infections developed in three patients with a posterior pelvic ring injury who had been treated with percutaneous fixation techniques. These were treated successfully with débridement. Nine patients complained of pain of pelvic origin. Nerve deficits recovered completely in four of the seven patients with preoperative neurologic deficiency. Moderate or major depression was diagnosed in sexually dysfunctional patients in the 12th postoperative month according to HDARS (r = -0.559, P < 0.001). At the last visit, there was an inverse correlation between ability to work and depression and anxiety (r = -0.551, r = -0.391). An inverse correlation was found between pain and ability to work (r = 0.597, P < 0.001). Of the 36 patients, 26 returned to their original jobs at the last follow-up visit.
  
  
  CONCLUSIONS
  Morbidity and mortality rates are higher in patients with a completely unstable pelvic ring injury. Emergency department stabilization and reconstruction of the pelvic ring with optimal operative techniques in these patients can reduce morbidity and mortality rates. Anterior and posterior internal fixation results in satisfactory clinical and radiologic outcomes. The affective status of patients is an important aspect that should be considered during the entire care of the patient.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D050723:Fractures, Bone / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D019529:Sexuality; D016896:Treatment Outcome