A nonunion of the pelvic ring after a pathologic or insufficiency
fracture of osteopenic bone is rare. The purpose of the present
study was to evaluate the radiographic and clinical results of in
situ fixation of these nonunions.
The records of forty-four patients who had been managed with in
situ fixation of pelvic fracture nonunions were reviewed retrospectively.
Twenty-seven patients had sustained pathologic fractures after a
simple fall, and seventeen had sustained insufficiency fractures.
Forty-two of the forty-four nonunions were unstable and were located
unilaterally or bilaterally in the posterior pelvic arch, and thirty-six
involved the lateral aspect of the sacrum. Two of the forty-four
non-unions involved only the pubic rami. The average age of the patients
was sixty-six years (range, thirty-five to eighty-seven years),
and the average duration of postoperative follow-up was four years
(range, two to eleven years). All patients were assessed with regard
to fracture union, residual pelvic pain, pelvic instability, and
functional status. In addition, all patients were asked to rate
the surgical result as highly satisfactory, satisfactory, or unsatisfactory.
Thirty-six (82%) of the forty-four nonunions healed after in situ
fixation, and seven of the eight persistent nonunions healed after
additional surgery. Thirteen patients (30%), including five patients
who had radiographic evidence of union, had persistent pain at the
one-year follow-up assessment. None of the forty-three patients
in whom the fractures eventually healed complained of persistent
pelvic instability. At the time of the final follow-up examination,
twenty-four patients (55%) were highly satisfied, twelve (27%) were
satisfied, and eight (18%) were unsatisfied with the surgical result.
In situ fixation of a nonunion of the pelvic ring following a pathologic
or insufficiency fracture can result in a decrease in pelvic pain
and instability along with an improvement in walking ability. A
high percentage of patients complain of persistent pain, even if
there is radiographic evidence of union of the pelvic ring.