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Late reconstruction of severe open-book deformities of the pelvis — tips and tricks

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Abstract

Background

The primary goal of treatment for open book pelvic injuries after high-energy trauma is to control haemorrhage and to close the pelvic ring anatomically. Less commonly, patients may present late with malunion or non-union.

Methods

We reviewed five operatively treated patients with delayed severe open book deformities who had a diastasis of more than 6 cm. We describe the pre-operative workup, surgical strategy and challenges experienced. They specifically include: extensive scar and contracture formation, malunion, urogenital prolapse and difficult reduction of vertical shear element. A 5 to 15-point clinical scoring system based on quality of life regarding pain, ambulation, social function, continence control and presence of prolapse is proposed.

Results

One elderly patient had early mortality after surgery. The other four patients had quality of life improvement by 3 to 5 points after one year. Correction is often clinically successful despite technical challenges and unpredictable radiological results.

Conclusion

External fixator and the C-clamp are good reduction tools. Powerful implants should be used and fixation of the posterior ring is mandatory. Staged urogenital and pelvic floor reconstruction is recommended before bony reconstruction to minimize the risk of wound contamination. Patients receiving this complex procedure have a good chance for improvement in pain and functional status.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China

    Christian Fang

  2. Department of Orthopaedic Trauma, RWTH University of Aachen, 30 Pauwels street, 52074, Aachen, Germany

    Hatem Alabdulrahman

  3. Department of Trauma, University of Zurich Hospital, Rämistrasse 100, 8091, Zürich, Switzerland

    Roman Pfeifer & Hans-Christoph Pape

  4. Department of Orthopaedic Surgery, Division of Traumatology, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA

    Ivan S. Tarkin

Authors
  1. Christian Fang
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  2. Hatem Alabdulrahman
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  3. Roman Pfeifer
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  4. Ivan S. Tarkin
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  5. Hans-Christoph Pape
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Correspondence to Christian Fang.

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The authors and their immediate family members declare no conflict of interest related to this study.

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Informed consent was obtained from all participants included in the study.

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Fang, C., Alabdulrahman, H., Pfeifer, R. et al. Late reconstruction of severe open-book deformities of the pelvis — tips and tricks. International Orthopaedics (SICOT) 41, 1777–1784 (2017). https://doi.org/10.1007/s00264-017-3549-4

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  • DOI: https://doi.org/10.1007/s00264-017-3549-4

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