title: Functional outcomes in women after high-energy pelvic ring injury.
abstract: OBJECTIVE
  Residual dysfunction after pelvic trauma has been previously described, but limited functional outcome data are available in the female population after high-energy pelvic ring injury. The purposes of this study were to determine functional outcomes and to characterize factors predictive of outcome.
  
  
  METHODS
  Prospective collection of functional outcomes data.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Eighty-seven women with mean age of 33.5 years and mean Injury Severity Score of 23.1 were included. The Orthopaedic Trauma Association classification included 32 B-type and 55 C-type fractures. Four were open fractures and six had bladder ruptures.
  
  
  METHODS
  Forty-nine patients were treated operatively and 38 nonoperatively.
  
  
  METHODS
  Musculoskeletal Functional Assessment (MFA) questionnaires were completed after a minimum of 16 months and a mean of 41 months of follow-up.
  
  
  RESULTS
  The mean MFA score was 33. Only 15 women (17.2%) had MFA scores comparable with an uninjured reference value (9.3), and 34 (39.1%) had better than the reference value for prior hip injury (25.5). Anteroposterior compression injuries had worse scores versus other patterns (48.3 vs 31.0, P = 0.01), and trends toward worse outcomes were noted after symphyseal disruption (P = 0.11) and transsymphyseal plating (P = 0.09). Sacral fracture or sacroiliac injury, amount of initial or final displacement, and type of posterior ring treatment were not associated with MFA scores. Mean scores were 32.3 after surgery and 34.0 after nonoperative management (P = 0.67). Functional outcomes were not related to age or Injury Severity Score, but isolated pelvis fractures had better MFA scores (21.1 vs 35.5, P = 0.008) and worse MFA scores (41.7 vs 29.1, P = 0.004) were seen with other lower extremity fractures. Those with bladder ruptures (n = 6) also had poor outcomes, mean MFA 50.0 (P = 0.078).
  
  
  CONCLUSIONS
  Wide variation is seen in functional outcome of women after high-energy pelvic ring fracture as measured by the MFA with mean scores demonstrating substantial residual dysfunction. Better outcomes were noted after isolated fractures and in women who had not sustained other fractures in their lower extremities. History of bladder rupture or anteroposterior compression injury was associated with poor MFA scores.
  
  
  METHODS
  Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH 44109, USA. hvallier@metrohealth.org
authors.forename: Heather A
authors.initials: HA
authors.lastname: Vallier
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Cureton
authors.forename: Dianne
authors.initials: D
authors.lastname: Schubeck
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D017102:Fracture Healing; D050723:Fractures, Bone / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult