Tornetta (1996) — Outcome of operatively treated unstable posterior pelvic ring disruptions.

Outcome of Operatively Treated Unstable Posterior Pelvic Ring Disruptions.

Tornetta, Matta·Clin Orthop Relat Res·1996·286 citations·Trauma

Retrospective cohort of 46 patients with 48 Type III (Bucholz) unstable posterior pelvic ring disruptions — all treated with ORIF — evaluated at mean 44 months for return to work, pain, ambulation, and neurologic status. The study asks: what functional outcomes should surgeons and patients actually expect after operative stabilization of these high-energy injuries?

Study Snapshot

Design

Retrospective cohort

Setting: 2 centers, Brooklyn NY and Los Angeles CA

Objective

Determine whether ORIF yields good functional outcomes in unstable posterior pelvic ring injuries

Outcome(s)

Return to work, pain, and ambulation at mean 44 months

Subjects

46 patients, 48 unstable posterior pelvic ring injuries

ORIF of unstable posterior pelvic ring

Inclusion

Type III unstable posterior pelvic ring injury
Treated with ORIF
Minimum 1-year follow-up

Follow-up

Mean 44 months (range 12–101)

Key Findings

67% of patients returned to their original jobs without restriction; an additional 14.5% changed jobs due to residual pelvic pain — not associated injuries — establishing operative stabilization as a defensible benchmark for counseling
63% had no pain or pain only with strenuous activity, and 63% ambulated without restriction — results the authors attribute to operative stabilization, noting prior nonoperative series inflated recovery rates by including less severe Type II injuries with intact posterior ligaments
Neurologic injury occurred in 35% overall and was the dominant driver of poor outcomes, with distribution varying markedly by injury pattern:
–Pure SI dislocations: 8/13 affected
–Sacral fractures: 6/11 affected
–Fracture-dislocations: 3/24 affected
Of those with neurologic injury: 27% had lower extremity weakness (half requiring an AFO), 13% had causalgia, 13% had sexual dysfunction — and only 1 patient achieved complete neurologic recovery
75% of injuries were reduced to ≤4 mm, yet reduction within 4 mm conferred no pain advantage over 4–10 mm, suggesting ≤10 mm is functionally adequate — though authors still advocate anatomic reduction given theoretical late arthritis risk
Satisfactory reduction did not improve neurologic outcomes, confirming that neurologic prognosis is fixed at the time of injury — not determined by operative technique

Clinical Relevance

When counseling a patient preoperatively for ORIF of a Type III unstable posterior pelvic ring injury, cite this series: roughly two-thirds can expect to return to their original job and ambulate without restriction, but one-third will have a significant neurologic injury that drives disability — and that neurologic deficit is determined at the moment of injury, not by how well you reduce the pelvis.

Associated injuries (ipsilateral acetabular fractures in 27% here) are often the bigger long-term functional limiter.

Supplemental

Outcome of Operatively Treated Unstable Posterior Pelvic Ring Disruptions.

Tornetta, Matta·Clin Orthop Relat Res·1996·286 citations·Trauma

Outcome of Operatively Treated Unstable Posterior Pelvic Ring Disruptions.

Study Snapshot

Key Findings

Clinical Relevance

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Outcome of Operatively Treated Unstable Posterior Pelvic Ring Disruptions.

Study Snapshot

Key Findings

Clinical Relevance

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Outcome of Operatively Treated Unstable Posterior Pelvic Ring Disruptions.

Study Snapshot

Key Findings

Clinical Relevance

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Outcome of Operatively Treated Unstable Posterior Pelvic Ring Disruptions.

Study Snapshot

Key Findings

Clinical Relevance

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