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Scott J, Glavy J, Deafenbaugh B, Kent W, LaCoursiere Y, Schwartz A, Lutgendorf M, Wheatley B. Do all patients with history of pelvic ring injuries need a cesarean section? - A survey of orthopaedic and obstetric providers. J Gynecol Obstet Hum Reprod 2024; 53:102779. [PMID: 38552957 DOI: 10.1016/j.jogoh.2024.102779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/22/2024] [Accepted: 03/24/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE(S) The recommended mode of delivery following pelvic ring fractures with surgical fixation is unclear. The objective of this study was to assess expert opinions from orthopaedic surgeons and obstetrician gynecologists on their recommended delivery recommendations for pregnant individuals with a history of pelvic ring injury, and to see if there was any difference in recommendations between the two specialties, and what factors influenced recommendations. STUDY DESIGN An electronic, web-based survey was administered to a convenience sample of orthopaedic surgeons and obstetrician gynecologists, via advertisement to members of the Orthopaedic Trauma Association (OTA), the Society for Maternal Fetal Medicine, and querying obstetrician gynecologists practicing within the Military Health System. The survey was administered from November 2021 to December 2022. A two-proportion z-test, Chi-square or Fisher's Exact Test, and descriptive statistics were used to analyze data. RESULTS Survey respondents included 44 orthopaedic surgeons and 37 obstetricians. A total of 74 % obstetricians would recommend a trial of labor with hardware in place, while orthopaedic surgeon's recommendations varied based on the type of fixation. Forty four, 100 % of orthopaedic surgeons, recommended trial of labor if non-operative pelvic injury or unilateral posterior fixation only, 88 % recommended trial of labor if bilateral posterior fixation only, and 47.7 % for anterior trans-symphyseal plating only, 50 % for unilateral posterior and trans-symphyseal plating, and 43.2 % for bilateral posterior fixation with trans-symphyseal plating. CONCLUSIONS The results of these surveys demonstrate the lack of consensus as to the most appropriate birth plan for patients with a history of pelvic ring injuries. Vaginal delivery following pelvic ring fracture and fixation is possible, yet these patients are significantly more likely to undergo cesarean section than the general population. As such, we recommend that women who become pregnant after operative treatment of a pelvic ring injury develop an in-depth birthing plan with their obstetrician to determine the best course.
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Affiliation(s)
- Jasmine Scott
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States.
| | - Jenna Glavy
- Department of Gynecologic Surgery and Obstetrics, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States
| | - Bradley Deafenbaugh
- Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, 620 John Paul Circle, Portsmouth, VA 23708, United States
| | - William Kent
- Department of Orthopaedic Surgery, University of California San Diego, 9500 Gilman Drive, San Diego, CA 92093, United States
| | - Yvette LaCoursiere
- Department of Gynecologic Surgery and Obstetrics, University of California San Diego, 9500 Gilman Drive, San Diego, CA 92093, United States
| | - Alexandra Schwartz
- Department of Orthopaedic Surgery, University of California San Diego, 9500 Gilman Drive, San Diego, CA 92093, United States
| | - Monica Lutgendorf
- Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, United States
| | - Benjamin Wheatley
- Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States
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Shaath MK, Garrett C, Pattisapu N, Routt MLC. Obstetricians are likely to elect for cesarean section in women with retained pelvic implants: a radiographic survey study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1345-1348. [PMID: 38133652 DOI: 10.1007/s00590-023-03803-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Women with a history of pelvic fracture undergo cesarean section (CS) at a higher rate than the general population. The purpose of our study is to query obstetricians on their preferences. METHODS An electronic survey consisting of 22 radiographs of patients who underwent pelvic fixation was sent to obstetricians at 3 academic medical centers. For each radiograph, a hypothetical scenario was given, and the respondents were asked if they would elect for a vaginal delivery or CS. RESULTS We collected 58 responses. The overall CS rate was 59%. Respondents were significantly more likely to elect for CS with trans-symphyseal fixation or sacroiliac fixation, independently (p < 0.001). DISCUSSION Obstetricians are likely to elect for elective CS in the presence of pelvic implants especially in patients with trans-symphyseal and sacroiliac fixation. Based on there is an opportunity for collaboration between orthopedic trauma surgeons and obstetricians.
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Affiliation(s)
- M Kareem Shaath
- Orlando Health Jewett Orthopedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 60 Columbia St., Orlando, FL, 32806, USA.
| | - Christopher Garrett
- Orlando Health Jewett Orthopedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 60 Columbia St., Orlando, FL, 32806, USA
| | | | - Milton L Chip Routt
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, McGovern Medical School at UTHealth, Houston, USA
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Lewis AJ, Barker EP, Griswold BG, Blair JA, Davis JM. Pelvic Ring Fracture Management and Subsequent Pregnancy: A Summary of Current Literature. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202402000-00005. [PMID: 38323930 PMCID: PMC10849384 DOI: 10.5435/jaaosglobal-d-23-00203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 02/08/2024]
Abstract
INTRODUCTION The incidence of pelvic ring injuries is 34.3% per 100,000 capita. No studies have determined the ability of a female patient to have a vaginal delivery after undergoing pelvic fracture fixation. However, many obstetricians are generally unwilling to have their patients attempt a vaginal delivery in the setting of symphyseal or sacroiliac fixation. METHODS An exhaustive search of the National Library of Medicine database was performed, and it is hypothesized that cesarean section rates would be higher for women who have a child after one of these pelvic ring injuries. RESULTS There is a 15% increase in cesarean rates using data from the National Center for Health Statistics. In addition, there is an observable increase in new cesarean rates. DISCUSSION Currently, there is no clear evidence to support an elective cesarean section as the sole indication after a prior pelvic fracture. To date, no studies have determined the ability of a female patient to have a vaginal delivery after undergoing pelvic fracture fixation. CONCLUSION Thus, until the increased cesarean section rate has been explained, it could be problematic to counsel the patient to avoid a vaginal delivery after sustaining a pelvic ring fracture. Hence, conducting additional studies on this topic would deem to be necessary.
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Affiliation(s)
- Allison J Lewis
- From the Medical College of Georgia at Augusta University, Augusta, GA (Ms. Lewis); the University of South Carolina School of Medicine, Columbia, SC (Ms. Barker); the Western Orthopaedics, Denver, CO (Dr. Griswold); the Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA (Dr. Blair); and the Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA (Dr. Davis)
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Parry JA, Strage KE, Lencioni A, Werner B, Mauffrey C. Should a history of pelvic fracture fixation be an indication for cesarean section? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-023-03804-7. [PMID: 38104045 DOI: 10.1007/s00590-023-03804-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To compare the success rate of a trial of labor (TOL) in a cohort of patients with pelvic fractures, with and without internal fixation, in order to better counsel patients and avoid unnecessary cesarean section (CS). METHODS A retrospective review of 35 female patients with 28 pelvic ring, five acetabular, and two combined fractures that had subsequent pregnancy; 12 patients had operative fixation and 23 did not. Fracture classification, treatment, type of fixation, mode of deliveries, and reason for CS were documented. RESULTS The rate of vaginal delivery, unscheduled CS, and scheduled CS across all patients was 80.0% (n = 28), 14.3% (n = 5), and 5.7% (n = 2), respectively, which was similar to institutional rates of 87.0, 12.0, and 1.0%. A TOL was attempted in 91.4% (32/35) and successful in 87.5% (28/32). Patients who failed a TOL were more likely to have Tile B/C pelvic fractures (100.0 vs. 30.4%, observed difference (OD) 69.6%, 95% confidence interval (CI) 16.4, 86.3%; p = 0.01) and more pelvic displacement (6.0 vs. 1.5 mm, OD 4.0, CI 1.0, 18.0; p = 0.01). The fixation and control groups had no observed difference in successful TOL (72.7% vs. 95.2%, OD 22.5%, - 49.7%, 5.5%; p = 0.10). CONCLUSIONS A majority of women had successful vaginal deliveries after pelvic fractures, with or without fixation, suggesting that these patients should consider a TOL. LEVEL OF EVIDENCE Diagnostic Level III.
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Affiliation(s)
- Joshua A Parry
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado Medical School, Denver Health, 777 Bannock St., MC 0188, Denver, CO, 80204, USA.
| | - Katya E Strage
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado Medical School, Denver Health, 777 Bannock St., MC 0188, Denver, CO, 80204, USA
| | - Alex Lencioni
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado Medical School, Denver Health, 777 Bannock St., MC 0188, Denver, CO, 80204, USA
| | - Bethany Werner
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado Medical School, Denver Health, 777 Bannock St., MC 0188, Denver, CO, 80204, USA
| | - Cyril Mauffrey
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado Medical School, Denver Health, 777 Bannock St., MC 0188, Denver, CO, 80204, USA
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Charsley J, Jarman H. Assessment and management of pelvic fractures from high-energy trauma in adults. Emerg Nurse 2023; 31:20-25. [PMID: 36880213 DOI: 10.7748/en.2023.e2151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 03/08/2023]
Abstract
Pelvic fractures caused by high-energy trauma such as falling from a height or road traffic collisions have a high mortality rate and patients are also at high risk of life-changing injuries. High-energy trauma to the pelvis is associated with major haemorrhage and injuries to the internal pelvic organs. Emergency nurses have a fundamental role in the initial assessment and management of patients, as well as in their ongoing care once the fracture has been stabilised and bleeding is controlled. This article describes the anatomy of the pelvis, discusses the initial assessment and management of patients who have sustained high-energy pelvic trauma, details the complications of pelvic fractures and explains patients' ongoing care in the emergency department.
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Affiliation(s)
- Julia Charsley
- Emergency Department Clinical Research Unit, St George's University Hospitals NHS Foundation Trust, London, England
| | - Heather Jarman
- midwifery and allied health professions, Emergency Department Clinical Research Unit, St George's University Hospitals NHS Foundation Trust, London, England
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Hsu CC, Lai CY, Chueh HY, Cheng PJ, Chang YL, Chao AS, Chang SD, Lai CH, Lo LM, Pan YB, Yang LY, Yu YH. Birth outcomes following pelvic ring injury: A retrospective study. BJOG 2023; 130:1395-1402. [PMID: 37039247 DOI: 10.1111/1471-0528.17487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To report obstetric outcomes in pregnant women with previous pelvic ring injury (PRI) and investigate the correlation between residual pelvic deformity and the mode of delivery. DESIGN Retrospective cohort study. SETTING Single medical centre in Taiwan. POPULATION Forty-one women with PRI histories from 2000 to 2021 who subsequently underwent pregnancy and delivery. METHODS All patients had complete PRI treatment and radiological follow up for at least 1 year. The demographic data, radiological outcomes after PRI and obstetric outcomes were collected to investigate the potential factors of delivery modes using non-parametric approaches and logistic regression. Caesarean section (CS) rates among different subgroups were reported. MAIN OUTCOME MEASURES Comparisons of demographic data and radiological outcomes (Matta/Tornetta criteria and Lefaivre criteria) after PRI among patients who had subsequent pregnancy and underwent vaginal deliveries (VD) or CS. RESULTS There were 14 VD and 27 CS in 41 patients. Nine patients underwent CS because of their PRI history, 12 patients underwent CS for other obstetric indications and 20 underwent trial of labour. Based on the logistic regression model, retained trans-iliosacral implants did not significantly increase the risk of CS (odds ratio [OR] 1.20; 95% CI 0.17-8.38). Higher pelvic asymmetry value by Lefaivre criteria was a potential risk factor for CS after previous PRI (OR 1.52; 95% CI 1.043-2.213). CONCLUSIONS VD is possible after PRI. Retained trans-iliosacral implants do not affect the delivery outcome. Residual pelvic asymmetry after PRI by Lefaivre criteria is a potential risk factor for CS.
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Affiliation(s)
- Chin-Chieh Hsu
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yang Lai
- Department of Orthopedic Surgery, Musculoskeletal Research Centre, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, Taoyuan, Taiwan
| | - Ho-Yen Chueh
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Cheng
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Lung Chang
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - An-Shine Chao
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Shuenn-Dyh Chang
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Liang-Ming Lo
- Department of Obstetrics and Gynaecology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Bin Pan
- Biostatistics Unit, Clinical Trial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Centre, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Hsun Yu
- Department of Orthopedic Surgery, Musculoskeletal Research Centre, Chang Gung Memorial Hospital, Linkou Branch, Chang Gung University, Taoyuan, Taiwan
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Chen K, Bhattacharjee S, Seidel H, Dillman DB, Strelzow JA. Association of Pelvic Trauma With Rates of Cesarean Section, Sexual Dysfunction, and Genitourinary Dysfunction in a National Database. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202304000-00006. [PMID: 37036931 PMCID: PMC10090791 DOI: 10.5435/jaaosglobal-d-22-00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/31/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Pelvic fractures are severe injuries that can drastically affect a woman's quality of life through sexual dysfunction (SD), genitourinary dysfunction (GD), and increasing the potential need for future cesarean section (C-section). Limited research has captured long-term outcomes after pelvic fractures in women of childbearing age. This study aimed to determine the association between pelvic fractures and rates of C-section, SD, and GD. METHODS All women of childbearing age who sustained a pelvic fracture were identified in a national insurance database. A comparison group of patients with lower extremity long-bone fractures was selected. Patients who gave birth after injury were additionally identified. A minimum of 5 years of follow-up was required for inclusion. Rates of C-section, SD, and GD were compared between cohorts. Multivariate logistic regression analysis was conducted with the inclusion of diabetes, tobacco, hypertension, obesity, and advanced maternal age. RESULTS A total of 6,174 patients with pelvic fracture and 27,154 control fracture patients were identified. 434 patients with pelvic fracture (7.0%) and 1,258 control fracture patients (4.6%) gave birth after fracture. Patients with pelvic fracture had a significantly higher rate of C-section (50.0% versus 38.8%, P < 0.001), SD diagnosis (10.9% versus 8.8%, P < 0.001), and urinary retention diagnosis (3.5% versus 2.8%, P < 0.001). No significant difference in global GD diagnosis was identified. Multivariate analyses showed that pelvic fracture was associated with C-section (odds ratio [OR]: 1.78; 95% confidence interval [95% CI]: 1.42 to 2.23, P < 0.001), SD diagnosis (OR: 1.23; 95% CI: 1.12 to 1.35, P < 0.001), and urinary retention diagnosis (OR: 1.35; 95% CI: 1.15 to 1.57, P < 0.001). DISCUSSION Pelvic fractures confer an intrinsic level of risk of C-section, SD, and urinary retention that is elevated beyond what would be expected from a traumatic lower extremity injury alone. Treating orthopaedic surgeons should actively counsel women regarding increased risks, openly discuss postinjury sequelae, and coordinate interspecialty care beyond initial treatment of acute trauma.
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Affiliation(s)
- Kevin Chen
- From the Pritzker School of Medicine at the University of Chicago, Chicago, IL (Mr. Chen, Dr. Bhattacharjee, and Mr. Seidel); and the Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine, Chicago, IL (Dr. Dillman and Dr. Strelzow)
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Fleifel D, Vaidya R, Nasr K. Pathologic Pubic Symphysis Diastasis in Pregnant Pelvic Ring Fracture Treated with INFIX: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00011. [PMID: 37071740 DOI: 10.2106/jbjs.cc.22.00790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
CASE Unstable pelvic ring fractures in pregnancy are an uncommon injury. Successful treatment of these patients with an INFIX device is even less common, with sparse literature to document the patient outcomes. We found no literature documenting the acute management of a pregnant patient with an INFIX device with (1) dynamic changes recorded, such as increasing pubic symphysis diastasis, and (2) restoration of normal symphyseal anatomy after birth and INFIX removal. CONCLUSION Use of a pelvic INFIX during pregnancy allowed functional independence. The construct offered sufficient stability while also allowing for pubic symphysis diastasis. After parturition, she returned to normal function with no injury sequela.
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Affiliation(s)
- Dominik Fleifel
- Department of Orthopaedic Surgery & Sports Medicine, Detroit Medical Center, Detroit, Michigan
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Vaajala M, Kuitunen I, Liukkonen R, Ponkilainen V, Kekki M, Mattila VM. The rate of elective cesarean section after pelvic or hip fracture remains high even after the long-term follow-up: A nationwide register-based study in Finland. Eur J Obstet Gynecol Reprod Biol 2022; 277:77-83. [PMID: 36037663 DOI: 10.1016/j.ejogrb.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/13/2022] [Accepted: 08/18/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There are only few studies on the effects of pelvic or hip fractures on subsequent delivery outcomes. The aim for this study is to evaluate in a nationwide sample whether the rate of elective CS and emergency CS would decrease during the time after maternal hip and pelvic fracture. MATERIAL AND METHODS In this nationwide registry-based study, data on all women aged 15-49 years with pelvic or hip fractures leading to hospitalization were retrieved from the Care Register for Health Care for the years 1998-2018. Wrist fractures were used as a control group. The data were linked with data from the National Birth Register, where each first pregnancy during the 14-year follow-up is collected. The delivery outcomes of these pregnancies were analyzed. The results were interpreted with odds ratios (OR), adjusted odds ratios (aOR), and 95 % confidence intervals (CI). RESULTS A total of 2878 women with pelvic fracture, 1330 women with hip fracture, and 29 580 with wrist fracture found in the Care Register for Health Care. Of these, a total of 586 (20.4 %) women gave birth during the following 14 years after pelvic fracture, 147 (11.0 %) women after hip fracture, and 5255 (17.7 %) women after wrist fracture. Women with pelvic fracture had higher odds for CS during each time period. The aOR for CS was 1.62 (CI 1.22-2.12) during first 5 years, 1.87 (CI 1.33-2.62) during years 5-10, and 1.97 (CI 1.11-3.41) during years 10-14. Women with hip fractures had notably higher odds for CS during first 5 years after fracture (aOR 1.64, CI 1.40-2.67). CONCLUSIONS The results of this study advocate that vaginal delivery is generally possible rather quickly after hip or pelvic fracture. Unplanned CS after hip fractures was more common at the beginning, but the exact reason for this remains unknown and further research should be made on this topic.
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Affiliation(s)
- Matias Vaajala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Ilari Kuitunen
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland; Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
| | - Rasmus Liukkonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; Department of Orthopaedics and Traumatology, Tampere University Hospital Tampere, Finland
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Pregnancy and delivery after pelvic fracture in fertile-aged women: A nationwide population-based cohort study in Finland. Eur J Obstet Gynecol Reprod Biol 2022; 270:126-132. [DOI: 10.1016/j.ejogrb.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 01/03/2023]
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Basile G, Passeri A, Bove F, Accetta R, Gaudio RM, Calori GM. Pelvic ring and acetabular fracture: Concepts of traumatological forensic interest. Injury 2022; 53:475-480. [PMID: 34865817 DOI: 10.1016/j.injury.2021.11.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fractures of the pelvic ring and acetabulum generally result after high energy trauma. Pelvic fractures, especially, are considered complex injuries from a therapeutic point of view, in relation to the frequent coexistence of skeletal and / or parenchymal lesions affecting other areas, and the abundant bleeding invariably associated with the latter. The systematic study of these injuries, starting from the 1950s, has led to a significant prognostic improvement, while generally remaining a non-negligible degree of disability. The knowledge of the characteristics of the lesions and of the classification systems, as well as an accurate assessment of the anatomo-functional repercussions, represent therefore the fundamental prerequisites for the correct assessment of physical damage. Herein, we aim to examine whether the medico-legal assessment parameters of physical damage being used in Italy and Europe are appropriate and consistent with the complexity of similar injuries.
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Affiliation(s)
- Giuseppe Basile
- Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute, Milano, Italy.
| | - Alberto Passeri
- Physician Specialist in Legal Medicine; via G. Garibaldi 110, 35043 Monselice (PD) - Italy
| | - F Bove
- Orthopedics and Traumatology Department, Niguarda Hospital, Milan, Italy
| | - R Accetta
- Trauma Unit and Emergency Department, IRCCS Galeazzi Orthopedics Institute, Milano, Italy
| | - R M Gaudio
- Department of Legal Medicine University of Ferrara
| | - G M Calori
- Department of Reconstructive and Prosthetic Revision-Surgery- and Sepsis, San Gaudenzio Clinic - High Speciality Institute, Novara, Italy
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Francis AO, McCabe F, McCabe P, O'Daly BJ, Leonard M. Pelvic and acetabular trauma in amateur equestrian enthusiasts - A retrospective review. Surgeon 2021; 20:164-168. [PMID: 33975806 DOI: 10.1016/j.surge.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Horse riding related accidents can present with devastating pelvic and acetabular fractures. This study examines the nature, management and treatment outcomes of severe pelvic and acetabular trauma in amateur horse riders presenting to a national tertiary referral centre. We also aim to define certain at-risk groups. METHODS This was a retrospective descriptive cohort of all patients who were referred to the National Centre for Pelvic and Acetabular trauma resulting from horse riding accidents. All patients who were referred to the National Centre for Pelvic and Acetabular Trauma between January 2018 and July 2020 were included. Professional horse riders were excluded. Clinical and treatment outcome measures were stratified to four different mechanisms of injury: fall from horse (FFH), horse crush (HC), Horse Kick (HK) and Saddle Injury (SI). RESULTS There were 31 equestrian related injuries referred to our centre between January 2018 and July 2020. One patient was a professional jockey and was thus excluded from the study. Eighteen were female and the mean age at referral was 37 years old. The majority of these were pelvic ring injuries (73%). Fifty per cent of patients required surgical intervention and the majority of these were male. CONCLUSION Horse riding is a potentially dangerous recreational pursuit with significant risk of devastating injury. Pelvic and acetabular fractures secondary to horse riding are frequently associated with other injuries and the need operative intervention is common in this group. Young women and older men are higher risk groups.
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Affiliation(s)
- A O Francis
- National Centre for Pelvic and Acetabular Trauma, Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, Ireland.
| | - F McCabe
- National Centre for Pelvic and Acetabular Trauma, Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, Ireland
| | - P McCabe
- National Centre for Pelvic and Acetabular Trauma, Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, Ireland
| | - B J O'Daly
- National Centre for Pelvic and Acetabular Trauma, Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, Ireland
| | - M Leonard
- National Centre for Pelvic and Acetabular Trauma, Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, Ireland
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Berndl A, Ladhani N, Wilson RD, Basso M, Jung E, Tarasoff LA, Angle P, Soliman N. Directive clinique no 416 : Soins pendant l'accouchement et la période post-partum chez les personnes ayant un handicap physique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:781-794.e1. [PMID: 33621681 DOI: 10.1016/j.jogc.2021.02.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Berndl A, Ladhani N, Wilson RD, Basso M, Jung E, Tarasoff LA, Angle P, Soliman N. Guideline No. 416: Labour, Delivery, and Postpartum Care for People with Physical Disabilities. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 43:769-780.e1. [PMID: 33631321 DOI: 10.1016/j.jogc.2021.02.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe evidence-based practice for managing the labour, delivery, and postpartum care of people with physical disabilities in Canada. TARGET POPULATION This guideline addresses the needs of people with physical disabilities, with a focus on conditions that affect strength and mobility, as well as those that affect neurological or musculoskeletal function or structure. Although aspects of this guideline may apply to people with solely intellectual, developmental, or sensory disabilities (e.g., hearing and vision loss), the needs of this population are beyond the scope of this guideline. OUTCOMES Safe and compassionate care for people with physical disabilities who are giving birth. BENEFITS, HARMS, AND COSTS Implementation of this guideline will improve health care provider awareness of specific complications people with physical disabilities may experience during labour, delivery, and the postpartum period and therefore increase the likelihood of a safe birth. EVIDENCE A literature review was conducted using MEDLINE (474), Embase (36), and the Cochrane Central Register of Controlled Trials (CENTRAL; 28) databases. The results have been filtered for English language, publication date of 2013 to present, observational studies, systematic reviews, meta-analyses, and guidelines and references in these publications were also reviewed. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). INTENDED AUDIENCE Maternal-fetal medicine specialists, obstetricians, family physicians, nurses, midwives, neurologists, physiatrists, and those who care for people with physical disabilities. RECOMMENDATIONS
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Is Previous Periacetabular Osteotomy Associated with Pregnancy, Delivery, and Peripartum Complications? Clin Orthop Relat Res 2020; 478:68-76. [PMID: 31425281 PMCID: PMC7000036 DOI: 10.1097/corr.0000000000000921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical candidates for periacetabular osteotomy are commonly women of reproductive age with symptomatic acetabular dysplasia. However, little is known about how this surgical intervention contributes to the decision to become pregnant, obstetrical counseling regarding delivery, mode of delivery, or pregnancy-related complications. QUESTIONS/PURPOSES (1) Does a history of periacetabular osteotomy affect a patient's decision to become pregnant or does it affect obstetrical counseling regarding the safety of pregnancy and childbirth? (2) Is history of periacetabular osteotomy associated with in an increased risk of undergoing cesarean section compared with the national average? (3) Is a history of periacetabular osteotomy associated with increased complications, decreased infant birth weight, preterm delivery? METHODS In conjunction with obstetrician colleagues, we created a survey to investigate patient attitudes toward pregnancy, mode of delivery, pregnancy-related complications, and obstetrical counseling among female patients who previously underwent periacetabular osteotomy. A retrospective cohort of reproductive-age women who underwent periacetabular osteotomy between 2008 and 2015 completed a mailed survey or telephone interview. All 96 patients who were contacted were asked if the history of periacetabular osteotomy affected their decision to become pregnant. Our cohort included 31 patients who had undergone periacetabular osteotomy and had a subsequent pregnancy and delivery with a total of 38 pregnancies resulting in 41 births. A binomial test was used to determine if the rates of cesarean section, low birth weight, or preterm delivery were different from the documented US national average as published by the National Vital Statistics Report and CDC. RESULTS One patient of 31 felt her periacetabular osteotomy negatively affected the appearance of her child; this surgical history affected 6.5% of patients (2 of 31) positively. Fifty-five percent (17 of 31) patients reported that their obstetrician expressed concern that their history of periacetabular osteotomy could affect their ability to carry to term or deliver vaginally. With a history of periacetabular osteotomy, 53% of deliveries (20 of 38) underwent cesarean section. This is higher than the national average of 32% (odds ratio 0.424 [95% confidence interval 0.214 to 0.837]; p = 0.006). Only one patient with a periacetabular osteotomy suffered a pregnancy-related complication. In singleton pregnancy after periacetabular osteotomy the preterm delivery rate was 14% (5 of 35) and the percentage of low-birth-weight infants was 2.9% (1 of 35). These percentages are not different from US data published by the National Vital Statistics Report, which reports an 8% preterm delivery rate (OR 0.523 [95% CI 0.154 to 1.772]; p = 0.1723) and 6.4% low birth weight (OR 2.34 [95% CI 0.607 to 9.025]; p = 0.3878) in singleton pregnancies. CONCLUSIONS In this small survey study, we found no differences in terms of complications, preterm delivery or low birth weight infants between patients who had a history of periacetabular osteotomy and normative national data regarding complications of pregnancy and delivery. However, we did note that patients with a history of periacetabular osteotomy were more likely to deliver future children by cesarean section, which could be attributable to obstetrician preference as most obstetricians in another small survey study have expressed concern about patients with a history of periacetabular osteotomy. Future studies should aim to increase the knowledge of the association of periacetabular osteotomy and delivery method, specifically with transition to cesarean for failure to progress during labor. Future consideration of using the Academic Network of Conservational Hip Outcomes Research repository to develop National Surgical Quality Improvement Program data may help to elucidate this relationship more clearly and help guide appropriate indications for scheduled cesarean sections in the setting of prior pelvic osteotomy. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Hernefalk B, Eriksson N, Larsson S, Borg T. Patient-reported Outcome in Surgically Treated Pelvic Ring Injuries at 5 Years Post-surgery. Scand J Surg 2019; 110:86-92. [PMID: 31537176 DOI: 10.1177/1457496919877583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Long-term prospective data on patient-reported outcome after surgical treatment of pelvic ring injuries are scarce. This study aimed at describing results at 5 years post-surgery using validated outcome measures. PATIENTS AND METHODS Patients admitted for surgical treatment of pelvic ring injuries were prospectively included and asked to report their outcome at 1, 2 and 5 years post-surgery using two patient-reported outcome measures: the generic Short-Form 36 and the condition-specific pelvic discomfort index. Data were evaluated using mixed-effects linear models. RESULTS There were 108 patients (68 males and 40 females), mean age 38 years. Injury type according to the AO/OTA-classification was B-type in 68 patients and C-type in 40 patients. No domain of the Short-Form 36 reached norm values at 5 years post-surgery. Females reported a worse outcome than males concerning general health (p < 0.01) at 5 years. Recovery of physical function (p < 0.01), mental health (p = 0.04), and pain (p = 0.01) was observed for males at 5 years compared to earlier assessments, while females on the contrary described more pain at this time-point (p = 0.03). Mean pelvic discomfort index at 5 years was 27, indicating moderate residual pelvic discomfort overall. Males reported less pelvic discomfort than females at 5 years (p = 0.02) and improved when compared to results at 2 years (p = 0.02), while females did not. Influence of age, fracture type, and presence of associated injuries on patient-reported outcome was limited. CONCLUSION Surgically treated pelvic ring injuries are associated with long-standing negative effects on patient-reported outcome. Males report a better outcome than females at 5 years post-surgery.
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Affiliation(s)
- B Hernefalk
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
| | - N Eriksson
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - S Larsson
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
| | - T Borg
- Department of Surgical Sciences, Section of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
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Psenkova P, Bucko M, Braticak M, Baneszova R, Zahumensky J. Impact of introducing specific measures to reduce the frequency of cesarean delivery for non-obstetric indications. Int J Gynaecol Obstet 2018; 142:23-27. [DOI: 10.1002/ijgo.12496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/19/2018] [Accepted: 03/23/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Petra Psenkova
- 2nd Department of Obstetrics and Gynecology; Faculty of Medicine in Bratislava of the Comenius University in Bratislava; Bratislava Slovak Republic
- University Hospital Bratislava; Bratislava Slovak Republic
| | - Marek Bucko
- Department of Obstetrics and Gynaecology; Trnava University Hospital; Trnava Slovak Republic
| | - Michal Braticak
- Department of Obstetrics and Gynaecology; Trnava University Hospital; Trnava Slovak Republic
| | - Ruth Baneszova
- 2nd Department of Obstetrics and Gynecology; Faculty of Medicine in Bratislava of the Comenius University in Bratislava; Bratislava Slovak Republic
- University Hospital Bratislava; Bratislava Slovak Republic
| | - Jozef Zahumensky
- 2nd Department of Obstetrics and Gynecology; Faculty of Medicine in Bratislava of the Comenius University in Bratislava; Bratislava Slovak Republic
- University Hospital Bratislava; Bratislava Slovak Republic
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Schwartsmann CR, Macedo CADS, Galia CR, Miranda RH, Spinelli LDF, Ferreira MT. Update on open reduction and internal fixation of unstable pelvic fractures during pregnancy: case reports. Rev Bras Ortop 2018; 53:118-124. [PMID: 29367917 PMCID: PMC5771786 DOI: 10.1016/j.rboe.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/23/2017] [Indexed: 12/02/2022] Open
Abstract
This article aims to report four cases of unstable pelvic fractures in pregnant women treated by open reduction and internal fixation. Cases report The study included four cases of pregnant women with unstable pelvic fractures; their outcomes were analyzed and discussed. Data were obtained from two University Hospitals. The mean age of women was 23 years; most (3/4) were primiparous, with a mean pregnancy age of 23 weeks. Two women had Malgaigne-type fractures and the other two had symphyseal disjunction associated with acetabular fractures. All fractures were treated surgically. One foetus was dead on admission to hospital. The other three developed well, along with their mothers. Good evolution was only possible with careful pre-, peri-, and postoperative care for the mother, as well as foetal assessment by a multidisciplinary team. In complex cases such as those presented in the present study, pre-, peri-, and postoperative care are mandatory, as well as the presence of a multidisciplinary team. The mother's life always takes priority in acute clinical pictures, as it offers the best chance of survival to both mother and child.
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Affiliation(s)
- Carlos Roberto Schwartsmann
- Departamento de Ortopedia e Traumatologia, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.,Departamento de Ortopedia e Traumatologia, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Carlos Alberto de Souza Macedo
- Departamento de Ortopedia e Traumatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Departamento de Ortopedia e Traumatologia, Hospital das Clínicas do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Carlos Roberto Galia
- Departamento de Ortopedia e Traumatologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Departamento de Ortopedia e Traumatologia, Hospital das Clínicas do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ricardo Horta Miranda
- Departamento de Ortopedia e Traumatologia, Hospital Mater Dei, Belo Horizonte, MG, Brazil
| | - Leandro de Freitas Spinelli
- Departamento de Ortopedia e Traumatologia, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Marco Tonding Ferreira
- Departamento de Ortopedia e Traumatologia, Hospital Mater Dei, Belo Horizonte, MG, Brazil
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Schwartsmann CR, Macedo CADS, Galia CR, Miranda RH, Spinelli LDF, Ferreira MT. Redução aberta e fixação interna em fraturas da pelve instáveis durante a gestação: relato de casos. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
Fracture management in pregnant patients is challenging. Anatomic and physiologic changes in pregnancy increase the complexity of treatment. Maternal trauma increases the risk of fetal loss, preterm birth, placental abruption, cesarean delivery, and maternal death. Initial resuscitation and treatment in a facility equipped to handle the orthopaedic injury and preterm births are paramount. Pelvic and acetabular injuries are potentially life threatening. The benefits and risks of surgical treatment must be carefully considered. The risks posed by anesthetic agents, antibiotic agents, anticoagulant agents, and radiation exposure must be understood. Positioning of the patient can affect the viability of the fetus. If surgery is necessary, the left lateral decubitus position decreases fetal hypotension. A specialized team including an obstetrician, perinatologist, orthopaedic surgeon, general trauma surgeon, critical care specialist, emergency medicine specialist, anesthesiologist, radiologist, and nurse must collaborate to improve maternal and fetal outcomes.
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