The impact of open reduction internal fixation on acute pain management in unstable pelvic ring injuries.
BACKGROUND
The management of unstable pelvic ring injuries is complex. Displacement is a clear indication for surgical intervention. However, reduction of acute pain after stabilization may have substantial clinical benefits and affect management decisions. The purpose of this study was to determine the impact of operative fixation of unstable pelvic ring injuries in diminishing acute pain.


METHODS
During a 33-month period, 70 patients with isolated pelvic ring injuries were managed at a Level-1 trauma center and retrospectively reviewed. On the basis of clinical and radiographic instability, 38 patients were managed surgically and formed the study group. Pain was assessed using visual analog scales and narcotic consumption during the index hospitalization.


RESULTS
In the operative group, visual analog scale scores decreased 48% after fixation from 4.71 +/- 1.8 preoperatively to 2.85 +/- 0.8 postoperatively (p < 0.001). Concomitantly, narcotic requirements decreased 25% from 2.26 mg morphine per hour preoperatively to 1.71 mg morphine per hour postoperatively (p = 0.024). The mean total length of hospital stay was 5.6 days (SD, 1.2 days), and the postoperative length of hospital stay was 4.7 days (SD, 1.2 days).


CONCLUSIONS
Operative reduction and fixation of unstable pelvic ring injuries significantly decreases acute pain. This has substantial physiologic benefits, particularly by improving mobilization, and should be an additional factor when determining surgical indication and timing.
Barei
David P
DP
Department of Orthopaedic Surgery, Harborview Medical Center, Seattle, Washington 98104, USA. barei@u.washington.edu
Shafer
Brian L
BL
Beingessner
Daphne M
DM
Gardner
Michael J
MJ
Nork
Sean E
SE
Routt
M L Chip
ML
D000328:Adult; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009294:Narcotics / Q000627:therapeutic use; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
D009294:Narcotics