الفهرس 
INTRODUCTION & AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Unstable pelvic ring injuries and open book injuries remain a
clinical challenge to be efficiently and promptly managed. Traumatic
disruptions of the pelvic ring result in an injury of varying degree to the
bony pelvis, and its soft tissue envelop. Various nerve, vessel, and
visceral structures may be damaged.
The aim of this study is to evaluate the results of management of
open book fractures with single symphseal plating versus double plating.
This work was carried out in Department of Orthopaedics and
Traumatology of Menofia University Hospital.
It included 20 cases with open book injuries.
The age of the patient ranged from 34 to 70 years with a mean
54.55 years.
Road traffic accidents were responsible for the majority of cases.
Males were more commonly affected than females with a ratio of
approximately 2:1.
Most patients were presented with open book fractures as a part of
polytrauma to different body regions. The commonest associated injuries
were located in the muskuloskeletal system. The lower extremities were
more affected than the upper extremities, femoral fractures were the
commonest.
Urological injuries were recorded in 2 cases (10%), abdominal
injuries were reported in 3 cases (15%), head injuries were reported in
3 cases (15%) and chest injuries were reported in 2 cases (10%).
The pelvic fractures were type B3.1 according to modified
Tile (1995) classification;
According to the Young and Burgess classification system,
most of the patients were of anteroposterior injury (APC) type
APC(I) 9 cases (45%),type APC(II) 9cases (45%) and APC(III)
2 cases(10%).
All the patients were treated by active resuscitation according to
the guidelines of the Advanced Trauma Life Support protocol, with
priority to cardiopulnionary conditions. At the same time primary and
secondary surveys were carried out to rule out any life-threatening
condition, and to evaluate the patient generally.
After resuscitation, all patients underwent meticulous clinical
examination and routine radiological views of the pelvis included
anteroposterior, inlet, and outlet views, in addition to C.T scanning were
taken.
Emergent pelvic binder was done as a part of primary resuscitation
for cases with haemodynamic and mechanical instability.
Open reduction and internal fixation were used in all 20 patients
(100%). Nine cases were fixed anteriorly with single plate, 11 cases were
fixed anteriorly with double plate.
For most cases, partial weight-bearing was started after 3 weeks
and progressed gradually to full weight-bearing after 6- 8 weeks guided
by radiological healing. The presence of lower limb fractures caused
delay of weight-bearing in some cases.
Reduction to within 10 mm seems to be adequate for functional
results. This may be because the pelvis exhibits only structural properties
with weight bearing and sitting as opposed to joint in which arthritis may
ensue in a short time if there is no anatomic reduction.
Early complications include :
Infection occurred in 4 cases (20%); three had deep wound
infection. The fourth was superficial wound infection.
Deep vein thrombosis occurred in one patient (5%).
Loss of reduction occurred in 3 cases (15%) and was more
common after type APC(II) fracture. Posterior displacement more than
10mm was reported in 3 cases.
Nonunion occurred in one patient (5%).
Implant loosening occurred in 2 patients (10%), screw
misplacement in one case (5%) and drill bit breakage in on case (5%)
Majeed et al., (1990) grading scale were used and the results was
unsatisfactory (Fair+poor) in 7 cases (35%) and satisfactory (excellent
+good) in 13 cases (65%).
The presence of associated injuries can have profound deleterious
effects on the final outcome of patients with pelvic fractures.