title: Percutaneous limited internal fixation combined with external fixation to treat open pelvic fractures concomitant with perineal lacerations.
abstract: External fixation combined with colostomy is a traditional management of the pelvic fractures associated with perineal lacerations. However, malunion and dysfunction caused by malreduction and loss of reduction are common. One-stage definitive fixation without soft tissue harassment is requisite for the treatment. The purpose of this study was to assess the outcome of 1-stage definitive fixation by combining percutaneous limited internal fixation and external fixation in the treatment of pelvic fractures with perineal lacerations. Eighteen adults with high-energy unstable pelvic ring fractures associated with perineal lacerations were admitted between June 2003 and December 2010. Mean follow-up was 28 months. After wound closure and colostomy, 10 patients received external fixation and percutaneous screw fixation, and 8 patients underwent external fixation. Demographics, wound and fracture classification, and Injury Severity Score were comparable between the groups (P>.05). Initial reduction quality was comparable between the groups (P=.14), but the loss of reduction during follow-up was more significant in the external fixation group (P=.004). Combined fixation achieved better functional results than external fixation (P=.02). There were 2 cases of superficial wound infection in each group (P=1.0). By combining debridement, wound closure, colostomy, percutaneous limited internal fixation, and external fixation, we improved pelvic fracture recovery while reducing the risk of infection. One-stage definitive fixation is a better choice than external fixation in the treatment of open pelvic fracture concomitant with perineal wound.
authors.affiliation: Department of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang Province, China.
authors.forename: Linwei
authors.initials: L
authors.lastname: Chen
authors.forename: Guoyou
authors.initials: G
authors.lastname: Zhang
authors.forename: Yaoshen
authors.initials: Y
authors.lastname: Wu
authors.forename: Xiaoshan
authors.initials: X
authors.lastname: Guo
authors.forename: Wen
authors.initials: W
authors.lastname: Yuan
mesh_terms: D000328:Adult; D017760:Bone Malalignment / Q000209:etiology; D003125:Colostomy / Q000379:methods; D016267:External Fixators / Q000009:adverse effects; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing; D005597:Fractures, Open / Q000150:complications / Q000601:surgery*; D006801:Humans; D022125:Lacerations / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010384:Pelvic Bones / Q000293:injuries*; D010502:Perineum / Q000293:injuries / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D015599:Trauma Severity Indices