The use of external fixators in the definitive stabilisation of the pelvis in polytrauma patients: Safety, efficacy and clinical outcomes

Objectives: To analyse the complications and outcomes (functional/radiographic) of Pelvic External Fixators applied as part of the definitive fixation in polytrauma patients.

Design: A single center retrospective chart review.

Setting: A level-1 trauma center.

Patients and methods: We reviewed all the polytrauma patients (ISS > 16) between 2007 and 2012 that had a PEF applied more than 30 days. Complications including infection, aseptic loosening, neurological injury, loss of reduction, non-union and mal-union were recorded. Pelvic asymmetry and Deformity Index (DI) were measured at the immediate postoperative radiographs and final follow-up. The functional outcome at final follow up was estimated using a scale previously reported by Chiou et al.

Results: 59 patients with mean age of 38.4 (16 − 81) years and mean ISS score 28 (16- 66) were included. The PEFs were applied for mean duration of 56 (30–104) days. The average follow-up was 403 days. 22 injuries were type B and 37 type C (AO/OTA). The most common symptomatic complications were pin site infection in 11 (18.6%) and loosening in 5 (8.5%) cases. 44 (74.5%) patients had satisfactory functional outcome. The immediate post-operative and final asymmetry and DI were compared between the two pelvic injury groups (type B and C fractures). The difference in displacement progression was more for type C injuries (p = 0.034) but no correlation to the functional outcome was evident.

Conclusion: PEF can be used as definitive alternative stabilization method in specific situations at polytrauma setting. Radiological displacement occurred in both type B and C injuries but the clinical outcome was not correlated to this displacement. Complications related to PEF do not affect the final clinical outcome.

Level of evidence: Therapeutic Level III.