The Hannover experience in management of pelvic fractures. ³

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Pohlemann T. Bosch U. Gansslen A. Tscherne H. Clinical Orthopaedics & Related Research. (305):69-80, 1994 Aug. Between 1972 and 1993, 1899 patients with fractures of the pelvis were treated at the authors institution. The pelvic ring was fractured in 1479 Á 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, Á 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. *