LONG-TERM RESULTS AFTER CONSERVATIVE TREATMENT OF PELVIC RING FRACTURES AND CONCLUSIONS FOR TODAYS MANAGEMENT

Until the early eighties conservative treatment was common even for unstable pelvic fractures. The longterm results of 114 non-operatively treated patients who had suffered a pelvic fracture (68 type A, 20 type B, 26 type C according to the classification of the ASIF) have been examined after an average time of 7.1 years after injury. 60 % of cases with a stable injury of the pelvis (type A) did not suffer of any complaint. The remaining patients stated moderate pain. After conservative treatment of type B pelvic injuries 55 % complained of pain or showed an impaired functional result. Former vertical-shear fractures (type C) showed worse results than type B pelvic injuries: only 15 % did not suffer of any pain and 10 % had no functional deficit. Patients with unstable pelvic fracture localized pain mainly in the lumbo- or iliosacral region. Radiological and CT findings suggest arthrosis, partial ancylosis and uncomplete reduction of the fracture as possible reasons for unsatisfactory clinical results. As consequence of these results we nowadays proceed extended radiological examinations (a.-p.-, inlet-, outlet-views, CT) and operative reduction and internal stabilization (ORIF) of all unstable pelvic fractures.