Henderson (1989) — The long-term results of nonoperatively treated major pelvic disruptions.

The Long-Term Results of Nonoperatively Treated Major Pelvic Disruptions.

Henderson·J Orthop Trauma·1989·149 citations·Trauma

Retrospective cohort study of 26 patients with major anterior-posterior pelvic ring disruptions (no acetabular involvement) treated entirely nonoperatively, reassessed at a minimum of 5 years (mean 8 years) to identify which injury characteristics predict long-term functional outcomes.

Study Snapshot

Design

Retrospective cohort

Setting: Single center, University of Iowa

Objective

Whether nonoperative treatment of major pelvic disruptions yields acceptable long-term outcomes

Outcome(s)

Long-term functional outcomes correlated with residual vertical displacement

Subjects

26 patients with anterior-posterior pelvic ring disruptions

Nonoperative treatment only: bed rest, traction, sling, or casting

Inclusion

Anterior and posterior pelvic ring disruption
No acetabular involvement
Acute hospitalization at University of Iowa

Exclusion

Unable to communicate due to cranial trauma (n=2)
Subsequent acetabular fracture-dislocation (n=1)
Lost to follow-up (n=4)

Follow-up

5–14 years (mean 8 years)

Statistics

Chi-square analysis

Key Findings

50% of patients had frequent or daily low back pain at follow-up — twice the rate of normal controls (25%), though not statistically significant (p = 0.09); patients were no more likely than controls to have sought medical care for back symptoms
Fracture stability was the strongest clinical predictor: frequent/daily back pain in 80% of unstable vs. 31% of stable injuries (p = 0.025); work disability in 80% vs. 13% (p < 0.01)
Residual vertical displacement graded on AP radiograph (none / <1 cm / >1 cm) predicted all outcomes. 100% of severely displaced patients had frequent/daily back pain vs. 18% with no displacement (p = 0.01)
Objective neurologic deficit in 42% overall; rose from 17% (no displacement) → 43% (slight) → 67% (severe), consistent with nerve injury driven by initial rather than residual displacement
46% reported distal dysesthesias and 38% had some degree of work disability; only 2 of 10 unstable injuries treated with traction showed measurable improvement in vertical displacement

Clinical Relevance

When managing major pelvic ring fractures nonoperatively, stability and residual vertical displacement on the AP radiograph are the key determinants of long-term pain, neurologic function, and ability to work — displaced (>1 cm) unstable injuries have poor outcomes with conservative care, while minimally displaced stable injuries do reasonably well, setting the framework for operative reduction thresholds still referenced today.

Supplemental

The Long-Term Results of Nonoperatively Treated Major Pelvic Disruptions.

The Long-Term Results of Nonoperatively Treated Major Pelvic Disruptions.

Study Snapshot

Key Findings

Clinical Relevance

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The Long-Term Results of Nonoperatively Treated Major Pelvic Disruptions.

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The Long-Term Results of Nonoperatively Treated Major Pelvic Disruptions.

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Key Findings

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The Long-Term Results of Nonoperatively Treated Major Pelvic Disruptions.

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Key Findings

Clinical Relevance

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