Unstable Pelvic Ring Injuries: How Soon Can Patients Safely Bear Weight?. Issue 2 (February 2019) - Marchand, Lucas S.
Abstract : Objective: To determine if time to weight bearing (WB) is associated with complications in operatively treated pelvic ring injuries. Design: Retrospective cohort study. Setting: Academic Level I trauma hospital. Patients: Two hundred eighty-six patients with pelvic ring injuries treated operatively over a 10-year period [OTA/AO 61-B1-3, 61-C1-3; Young-Burgess lateral compression (LC) 1–3, anterior–posterior compression (APC) 1–3, and vertical shear] were included. Intervention: Patients were stratified into early (⩽8 weeks) and late (>8 weeks) time to full WB groups. Main Outcome Measure: Composite outcome of implant failure [broken screw(s)/plate(s), screw(s) loosening], revision surgery, and malunion. Results: We identified 286 patients with a mean age of 39.9 years (range: 18–81 years) and an average follow-up of 1.2 years (1.0–9 years). There were 132 and 154 patients in the early and late WB groups, respectively. A total of 142 Young-Burgess LC-1, 48 LC-2, 23 LC-3, 10 APC-1, 45 APC-2, 8 APC-3, and 8 vertical shear injuries were noted. Complications were noted in 47 patients (16%). Complications included 18 implant failures, 16 malunions, and 13 patients who required revision operations for loss of reduction. Time to WB was not associated with composite complication rates ( P = 0.24). APC-2, LC-3, and injuries with bilateral rami fractures were noted to have a higher complication rates independent of time to WB ( P = 0.005, 0.03, and 0.03, respectively). Conclusions: No difference in implant failure, malunion, or early loss of reduction between operatively treated pelvic ring injuries allowed to WB as tolerated before 8 weeks compared with those who remained on protected WB protocol for any time greater than 8 weeks was noted. These data may provide information to support early WB protocols. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Abstract : Supplemental Digital Content is Available in the Text.