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Geoffrey S. Connor, MD, Gerald
McGwin, Jr., MS, PhD, Paul MacLennan, PhD, Jorge Alonso, MD,
Loring Rue, III, MD
Introduction: It has been demonstrated
that early timing of fixation can be of significance in decreasing
morbidity from femoral and acetabular fractures. There is
currently little evidence in the literature to guide the clinician
for the optimal timing of pelvic ring fractures. The intent
of this study is to review a large series of patients with
fractures of the pelvic ring in an effort to define the effect
of surgical timing on hospital course in terms of pulmonary
complications, length of hospital stay, and cost of hospitalization.
Methods: The hospital course
of 151 consecutive patients with pelvic ring fractures between
June 1996 and December 2000 was reviewed. Pelvic radiographs
were classified according to the modified Tile system. Tile
fracture types B and C patients who underwent fixation within
one week of injury (n=71) were compared to those in whom surgery
was delayed beyond one week (n=28).
Results: Early and delayed fixation
groups were statistically equivalent in terms of gender, race,
and mean age. Early repair patients had a lower risk of pulmonary
complications (RR=0.49, 95% CI=0.25-0.96), a reduced length
of hospital stay (12.2 vs. 20.5 days; p=0.0005) and overall
reduced cost of care ($57,084 vs. $158,625; p=0.0317).
Conclusions: Pelvic ring fixation
within the first week of injury results in significantly reduced
incidence of pulmonary complication, hospital stay, and cost
of care regardless of injury severity or fracture classification.
The current study, to our knowledge, represents the largest
cohort of patients sustaining pelvic ring fractures represented
in the literature. It is clear that the coordinated team approach
to insure prompt resuscitation, stabilization, and operative
fixation results in the more optimal patient outcomes.
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