Complex Pelvic Fractures: Emergency Room to Internal Fixation - A Case Series And Literature Review

A complex pelvic fracture is defined as a pelvic fracture that occurs together with an additional organ injury in the pelvic region, and includes urogenital, gastrointestinal, neurological and retroperitineal vessel injury. Besides these additional organ injuries, complex pelvic fractures are almost always unstable. The orthopedic surgeon managing complex unstable pelvic fractures must conceptually divide their management into the measures taken in the Emergency room setting, intermin measures, and definitive measures aimed to restore pelvic stability. Regarding Emergency room measures, circumferential sheeting, external pelvic fixation device, and the pelvic C-clamp, are all acceptable measures employed as part of patient resuscitation. The more historial pelvic sling, and frequently used external pelvic fixation device are both acceptable intermediate stabilization measures. Definitive management is reserved for unstable pelvic fractures where anatomical alignment cannot be achieved by external means. The complications of prolonged external pelvic fixation is however appreciated, and in centers experienced in the technique, internal plating fixation is preferred. We reported a series of two patients with complex unstable pelvic fractures, further complicated by acetabular fractures that were ultimately managed by internal fixation and a total hip replacement. Our case series followed these two patients from the emergency room setting until their definitive internal plate fixation and concluded by an evaluation of functional outcome assessed with Majeed score. The essential principles in the management of these patients are highlighted together with the frequent complications reported and our series is valuable to those orthopedic surgeons involved in the management of these challenging patients.