Friday February 23, 1996

Rapid treatment of pelvic fractures may help prevent malunions

Patients with pelvic fractures requiring surgery should be treated as soon as possible to prevent malunions

Pelvic fracture malunion can produce pain and affect the patient's ability to return to work, to walk, or even to sit, said Kyle Dickson, MD, who reported his findings in scientific exhibit S 06.

"It's also easier to surgically move the injured bones into proper position just after a fracture occurs," said Dr. Dickson, assistant professor of orthopaedics, and director of trauma-orthopaedics, Tulane University; and chief of orthopaedics, Charity Hospital, both in New Orleans.

Conservative treatment of serious acute pelvic fractures caused by motor vehicle accidents, falls, or other trauma will quite possibly require a more complicated surgery later on.

"Waiting a few weeks/months to see how fracture healing progresses risks letting it heal in a deformed state," said Dr. Dickson.

Trauma often happens to younger people, who have many more years to live with the deformity.

In the study which Dr. Dickson presented, orthopaedic researchers reviewed the medical records, X-rays, and personal follow-up of 21 patients who had sustained a pelvic fracture an average of 46 months earlier. All 21 patients, treated conservatively at other institutions, had significant disability with sitting, pain, leg length discrepancy, or instability.

"All of these patients required a complex three stage pelvic reconstruction procedure," said Dr. Dickson.

At follow-up (average 25.8 months), 20 out of 21 patients said the surgery helped them. Eighty-five percent of the pelvic deformities were corrected. Twelve out of 16 patients returned to their previous work. The deformity complaints (i.e. sitting imbalance and leg length discrepancy) were improved in 100 percent of the patients (20 out of 20). However, back pain was still present in 79 percent of the patients (9 out of 14) despite 95 percent (18 out of 19) saying the severity lessened.

"Early operative treatment to prevent pelvic malunion is best for patient outcomes," said Dr. Dickson.

Co-author of the study with Dr. Dickson is Joel M. Matta, MD, associate clinical professor, department of orthopaedic surgery, University of Southern California School of Medicine, Los Angeles.

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