Study design
This was a hospital based prospective observational study carried out from 1st of January 2009 to 31st of December 2018 at the Limbe Regional Hospital. It is a level III health institution located in the South West region of Cameroon and has a capacity of 200 beds. The surgical ward has a capacity of 26 beds, and there are 5 surgical specialists including one orthopaedic surgeon, one general surgeon, one urologist, and two ENT surgeons.
Study population and sampling
The study involved all patients with unstable pelvic fractures who were admitted and treated at the Limbe Regional Hospital within the 10 years’ period. The sampling was done in a consecutive manner.
Selection criteria
Inclusion criteria: All cases of unstable pelvic fractures aged above 18 that were admitted, treated, and followed-up at the Limbe Regional Hospital were included in the study
Exclusion criteria: Patients from whom relevant data could not be obtained and those who didn’t consent for the study were excluded. Patients who were initially treated for the same fracture in another hospital were equally excluded.
Study procedure
Patients with unstable pelvic fractures who were admitted, treated, and discharged were approached during the routine visits at the clinic or contacted by telephone to report for evaluations. Those who met the inclusion criteria were counselled on the aim and importance of the study. Information concerning patient demographics, history, clinical evaluation, and radiological exams were recorded on a data entry form.
On admission, all patients were initially evaluated at the emergency department of the hospital. Patients with unstable clinical states were urgently resuscitated appropriately. All those who were suspected of having a pelvic fracture had a pelvic binder applied at the emergency, or were taken to the operating room where external fixators or pelvic clamps were applied. After adequate stabilisation, definitive pelvic fixation was planned for the patients.
In this study, Pelvic fractures were classified according to the Tile’s classification system. Tile B and Tile C are classified as unstable while Tile A are considered stable[12].
The patients were definitively managed either surgically or conservatively. The decision for definitive management modality was guided by patients’ age, co-morbidities, clinical condition, injury pattern and financial constraints. Conservative management modalities included the use of pelvic binders, pelvic clamps, and skeletal traction depending on the fracture type and pattern. Surgical stabilisation modalities included internal fixations with plates and screws, external fixations, ilio-sacral screws or combination of these, without the use of image intensifier. The patients were all asked not to fully bear weight until after 3 months or when there’s radiological evidence of consolidation. After discharge, follow-up visits were scheduled every 45 days during which the patients were thoroughly examined for any complications. The functional outcome was evaluated using the Majeed scoring system [13]. This score includes constitutes 4 grades determined clinically and evaluated on 100 points. The outcome is graded as excellent (value>85), good (value between 70-84), fair (value between 55-69), and poor (value <55).
Data management and analysis
Data was kept secured and all information was recorded in a computer protected by a password. Epi Info software was used to analyse this data. Results were represented on tables to ease organization and comprehension.
Ethical consideration
Ethical clearance was obtained from the Faculty of Health Sciences of the University of Buea Institutional Review Board (IRB). An administrative approval was obtained from the regional delegate of public health and the director of the Limbe regional hospital. A consent form was presented to participants explaining the procedure and goals of the research.