Short term outcomes of unstable pelvic fractures in adults treated at Mulago National Referral Hospital

Abstract

Introduction Pelvic fractures are perhaps the most severe & life-threatening musculoskeletal injuries, constituting about 1.5%–3% of all skeletal injuries. Despite their severity, unstable pelvic fractures can yield favorable outcomes, particularly when timely and appropriate management strategies are implemented. However, some patients who survive may incur temporal or permanent disabilities affecting function. Thus, the study aimed to describe the functional and radiological outcomes of unstable pelvic fractures of adults treated at MNRH. Methods We recruited 51 patients consecutively from November 2024 to February 2025. Functional outcomes were assessed using the Majeed Pelvic score, while Radiological outcomes were evaluated for bony union, non-union, and malunion. Data was collected using a structured questionnaire and analyzed using STATA version 15. Continuous variables were summarized using the median and interquartile ranges, while the categorical variables were summarized using frequencies and proportions. Figures and tables were used to present the data. Results The median age was 31 (IQR 25,38), and the male sex dominated 56.9% (n=29). Road traffic accidents were the commonest mechanism of injury, 88% (n=45), with Tile B fractures being the most predominant. Operative fracture management dominated by 54.9% (n=28), 21% (n=11) had associated nerve damage, and only 11.8% (n=6) did not adhere to the rehabilitation protocol. A satisfactory functional outcome was observed among 57% (n=29) of the patients, and of these, Tile B fracture dominated with 68.9% (n=20). Radiological union occurred among 78% (n=40) of the patients. The factors associated with the unsatisfactory short-term functional outcome were non-adherence to the rehabilitation protocol [PR 1.22, 95% CI (1.05 – 1.42)], and being managed non-operatively [PR 1.34, 95% CI (1.16 – 1.55)]. Falling from heights as a mechanism of pelvic injury [PR 0.80, 95% CI (0.67 – 0.94)] and having an occupation following injury [PR 0.77, 95% CI (0.66 – 0.91)] were associated with reduced prevalence of unsatisfactory functional outcomes. Conclusion In this study, 57% of the patients with unstable pelvic fractures had satisfactory functional outcomes following treatment. Radiological union rates showed better results with 78% attaining union. Being managed operatively and adherence to rehabilitation protocol were associated with satisfactory functional outcomes.