The Hannover experience in management of pelvic fractures.

Between 1972 and 1993, 1899 patients with fractures of the pelvis were treated at the authors institution. The pelvic ring was fractured in 1479 patients, and 1029 sustained polytrauma. A retrospective study included four parts: (1) Demographic analysis of 1409 patients showed an increase in the severity of pelvic and general trauma during this period. The 17.7% mortality rate was predicted by the Hannover Polytrauma Score and associated extrapelvic blunt trauma. (2) Residual displacement after operative treatment of the pelvis was analyzed in 221 patients. In C type (Tile) fractures residual displacement correlated with external fixation and solely anterior stabilization. (3) Outcome after operative treatment was analyzed in a consecutive series of 58 patients an average of 2.2 years after trauma. Pelvic pain was frequent (Type B 11%, Type C 66%) and correlated with posterior displacement over 5 mm and primary neurological injuries. (4) Mortality after complex pelvic trauma (pelvic fracture with soft tissue injury) decreased from 48.1% to 29.6% during these years. Standardized protocols for primary care and operative procedures of pelvic injuries optimize therapy. Complex pelvic trauma requires early, aggressive surgical management with surgical hemostasis. Further developments in open reduction and internal fixation of the pelvis focus on minimizing additional soft tissue trauma and implants.