In situ fixation of pelvic nonunions following pathologic and insufficiency fractures.

BACKGROUND

A nonunion of the pelvic ring after a pathologic or insufficiency fracture of osteopenic bone is rare. The purpose of the present study was to evaluate the radiographic and clinical results of in situ fixation of these nonunions.

METHODS

The records of forty-four patients who had been managed with in situ fixation of pelvic fracture nonunions were reviewed retrospectively. Twenty-seven patients had sustained pathologic fractures after a simple fall, and seventeen had sustained insufficiency fractures. Forty-two of the forty-four nonunions were unstable and were located unilaterally or bilaterally in the posterior pelvic arch, and thirty-six involved the lateral aspect of the sacrum. Two of the forty-four non-unions involved only the pubic rami. The average age of the patients was sixty-six years (range, thirty-five to eighty-seven years), and the average duration of postoperative follow-up was four years (range, two to eleven years). All patients were assessed with regard to fracture union, residual pelvic pain, pelvic instability, and functional status. In addition, all patients were asked to rate the surgical result as highly satisfactory, satisfactory, or unsatisfactory.

RESULTS

Thirty-six (82%) of the forty-four nonunions healed after in situ fixation, and seven of the eight persistent nonunions healed after additional surgery. Thirteen patients (30%), including five patients who had radiographic evidence of union, had persistent pain at the one-year follow-up assessment. None of the forty-three patients in whom the fractures eventually healed complained of persistent pelvic instability. At the time of the final follow-up examination, twenty-four patients (55%) were highly satisfied, twelve (27%) were satisfied, and eight (18%) were unsatisfied with the surgical result.

CONCLUSIONS

In situ fixation of a nonunion of the pelvic ring following a pathologic or insufficiency fracture can result in a decrease in pelvic pain and instability along with an improvement in walking ability. A high percentage of patients complain of persistent pain, even if there is radiographic evidence of union of the pelvic ring.