Traumatic spinopelvic dissociation managed with bilateral triangular osteosynthesis: Functional and radiological outcomes, health related quality of life and complication rates

Background: Spinopelvic dissociation (SPD) is difficult to manage and is associated with high mortality and morbidity, including concomitant orthopaedic polytrauma, spine injuries, pelvic ring disruptions, neurological, soft-tissue, and vascular injuries. The purpose of this study is to evaluate the functional and radiological outcomes; health related quality of life and complication rates of patients with traumatic spinopelvic dissociation underwent bilateral triangular osteosynthesis (TOS).

Methods: The study was approved by the medical school's institutional review board (IRB). Prospective data collection of nineteen consecutive cases of traumatic SPD were included in the study from October 2015 to August 2018. Bilateral TOS was performed to manage all patients with SPD. The clinical outcome for fractures was analyzed with Majeed function assessment. Health Related Quality of Life (HRQoL) was assessed with the EQ-6D questionnaire. The reduction quality was evaluated according to Matta criterion. CT scanning was used to verify the fracture union in patients at 24^th weeks postoperatively.

Results: There were 12 women and 7 men with an average age of 47.2±8.4 years (range, 17-62 years). The average follow-up time was 25.2±3.7 months (average, 22-45 months). The most common mechanism of injury was falling (57%). According to Majeed functional scoring, the results were excellent in 12 cases, good in 5 cases and fair in 2 cases. The median EQVAS score was 78.9±8.4. 15 patients (78.9%) turned back to their original occupation. Pain and mood disorders mainly influenced patients' present general health status. According to Matta criterion for fracture reduction, the results were excellent in 14 cases, good in 4 cases and fair in 1 case. Complications were noted as wound healing problems (26%), implant loosening (5%) and iatrogenic nerve injury (5%).

Conclusion: Bilateral TOS demonstrates satisfactory functional and radiological outcomes with low complication rates except infection rate in patients with traumatic spinopelvic dissociation. HRQoL is mainly dominated by pain and mood disorders. 78.9% of the patients turned back to their original occupation. Surgeons should be aware of wound healing problems in case of increased muscle mobilization and degloving injuries.Implant removal is required to improve the lumbopelvic mobility.