Q1.What types of pelvic fractures require surgical fixation?
Not all pelvic fractures require surgery. Dr. Kumar recommends surgical fixation for: (1) Unstable pelvic ring fractures that involve both anterior and posterior pelvic structures (Young-Burgess classification LC-II, LC-III, APC-II, APC-III, VS), (2) Displaced acetabular fractures involving the hip joint, (3) Fractures with significant displacement that cannot be adequately reduced with closed methods, (4) Open pelvic fractures with contamination, (5) Fractures in patients who need early mobilization to prevent complications, (6) Fractures with associated neurovascular injury requiring repair. Stable, minimally displaced fractures (LC-I, APC-I) can often be treated non-surgically with bed rest and gradual mobilization. The decision is made based on fracture pattern, displacement, patient age, activity level, and associated injuries after comprehensive evaluation with X-rays and CT scan.
Q2.What are the surgical approaches used for pelvic fracture fixation?
Dr. Kumar uses several surgical approaches depending on fracture location: (1) Ilioinguinal approach for anterior pelvic ring and acetabular fractures, (2) Pfannenstiel (modified bikini) incision for pubic symphysis disruption, (3) Stoppa approach for internal access to anterior pelvis, (4) Lateral window for iliac wing fractures, (5) Posterior approaches (Kocher-Langenbeck) for posterior wall and column acetabular fractures and sacroiliac joint disruptions, (6) Percutaneous techniques for sacroiliac screws and pubic ramus screws with fluoroscopic guidance. Many cases require combination approaches to address both anterior and posterior injuries. Minimally invasive percutaneous fixation is preferred when possible to reduce tissue trauma, blood loss, and infection risk. The approach is carefully planned based on 3D CT reconstruction showing exact fracture pattern and location.
Q3.What are the risks and complications of pelvic fracture surgery?
Pelvic fracture surgery carries significant risks due to the complex anatomy and proximity to vital structures. Potential complications include: (1) Blood loss requiring transfusion (10-15% of cases), (2) Infection (superficial or deep, 5-8%), (3) Nerve injury causing numbness, weakness, or foot drop (3-5%), particularly lateral femoral cutaneous nerve or sciatic nerve, (4) Vascular injury to iliac vessels (rare but serious), (5) Heterotopic ossification (abnormal bone formation) in 10-15% requiring prophylaxis, (6) Deep vein thrombosis (DVT) and pulmonary embolism (5-10% despite prophylaxis), (7) Sexual dysfunction or urinary problems from nerve injury (2-5%), (8) Malunion or nonunion requiring revision surgery (5%), (9) Hardware failure, loosening, or prominence causing pain, (10) Leg length discrepancy or persistent pelvic asymmetry. Dr. Kumar uses meticulous surgical technique, fluoroscopic guidance, and comprehensive DVT prophylaxis to minimize these risks. Despite careful surgery, pelvic fractures have higher complication rates than other fractures due to injury severity.
Q4.How long does it take for a pelvic fracture to heal after surgery?
Pelvic fracture healing is a gradual process. Bone healing timeline: (1) Early callus formation: 4-6 weeks, (2) Bridging callus: 8-12 weeks, (3) Bone consolidation: 3-6 months, (4) Complete remodeling: 12-24 months. Weight-bearing progression follows healing: non-weight bearing for 6-8 weeks, partial weight bearing 8-12 weeks, full weight bearing at 12-16 weeks (if X-rays show adequate healing). Return to activities: light daily activities at 3-4 months, driving at 3-6 months (with surgeon clearance), physically demanding work at 6-9 months, running/sports at 9-12 months if appropriate. Many factors affect healing rate including fracture pattern, quality of reduction, patient age, smoking status, nutrition, and compliance with restrictions. Complex fractures or those with complications may take longer. Dr. Kumar monitors healing with serial X-rays at 6 weeks, 12 weeks, and 6 months, adjusting weight-bearing restrictions based on radiographic evidence of healing. Complete functional recovery may take 12-18 months.
Q5.Will I need to have the metal implants removed after pelvic fracture surgery?
In most cases, pelvic fracture fixation hardware (plates and screws) can remain permanently and does not need removal. Indications for hardware removal include: (1) Prominent implants causing pain, skin irritation, or difficulty sitting, (2) Infection that cannot be controlled with antibiotics alone, (3) Hardware failure or breakage, (4) Young patients with pubic symphysis plates that may interfere with future childbirth (discussed on case-by-case basis), (5) Patient preference after complete healing (rare). Advantages of leaving hardware: avoids another surgery and anesthesia, maintains stability if bone quality uncertain, no risk of re-fracture during removal. If removal becomes necessary, it is typically performed 12-18 months after initial surgery once complete bone healing is confirmed. The removal procedure is generally shorter and less complex than the original fixation surgery, but still requires anesthesia and carries surgical risks. Dr. Kumar uses titanium implants which are MRI-compatible and rarely cause issues long-term. Most patients (>90%) never require hardware removal.
Q6.What is the cost of pelvic fracture fixation surgery at Arthoscenter Patna?
Pelvic fracture fixation surgery cost varies significantly based on fracture complexity and extent of fixation required. At Arthoscenter Patna under Dr. Gurudeo Kumar, approximate costs are: Simple anterior ring fixation: ₹1,80,000-2,50,000, Complex pelvic ring fixation (both anterior and posterior): ₹2,50,000-4,00,000, Acetabular fracture fixation: ₹2,80,000-4,50,000, Multiple approaches or extensive fixation: ₹4,00,000-6,00,000+. Package includes: all pre-operative investigations, 3D CT planning, surgery charges, anesthesia, implants (plates and screws), ICU care, hospital stay (5-14 days), physiotherapy consultation, follow-up visits for 3 months. Additional costs may include: blood transfusion if needed (₹5,000-15,000 per unit), extended ICU stay beyond included days, management of associated injuries, medications after discharge, outpatient physiotherapy. Many factors affect final cost: number of implants needed, surgical time, hospital stay duration, need for advanced imaging, complications requiring additional treatment. Insurance coverage is usually available for trauma surgery. Dr. Kumar provides transparent pricing during consultation after reviewing imaging. A ₹999 initial consultation allows detailed discussion of your specific case and accurate cost estimate.