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Yoon YC, Parry JA, Mauffrey C. Comparative study on anterior pelvic plating and pubic ramus screw fixation for straddle fracture: a matched-pair outcome analysis. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06338-7. [PMID: 39340641 DOI: 10.1007/s00264-024-06338-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024]
Abstract
PURPOSE Straddle fractures involving both the superior and inferior rami often require surgical fixation due to instability. This study compared the clinical and radiological outcomes of pubic ramus screw fixation (PRSF) and anterior pelvic plating (APP) for the treatment of these fractures to identify the superior method. METHODS A retrospective analysis was conducted on 70 patients (37 males, 33 females; average age 47.6 years) treated surgically for straddle fractures at two Level 1 trauma centres between May 2017 and August 2022. The patients were divided into two groups, where 26 underwent PRSF and 44 underwent APP. The groups were matched based on preoperative characteristics such as age, sex, body mass index, injury mechanism, and severity. The key variables analysed included operation time, blood transfusion volume, early weight-bearing capability, and complication and reoperation rates. RESULTS After matching, PRSF was associated with a shorter operative time (71.0 min vs. 118.3 min for APP, p < 0.0009) and lower blood transfusion requirements (0 units vs. 1 unit, p < 0.0001). Postoperatively, 61.5% of PRSF patients tolerated early weight-bearing, compared to none in the APP group. However, in two cases, PRSF could not be performed due to severe comminution or anatomical limitations, necessitating conversion to APP. Complication rates were similar between the groups (30.8% for PRSF vs. 27.3% for APP, p = 0.93). CONCLUSION PRSF demonstrated advantages, such as shorter operative time, reduced blood transfusions, and earlier weight-bearing. However, APP remains valuable for complex fracture patterns. Treatment should be individualized based on fracture complexity and patient-specific factors to optimize outcomes.
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Affiliation(s)
- Yong-Cheol Yoon
- Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, 21 Namdong-daero, 774 Beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Joshua A Parry
- Department of Orthopedics, Denver Health Medical Center, 777 Bannock St, Denver, MC, Colorado, 0188, 80204, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Cyril Mauffrey
- Department of Orthopedics, Denver Health Medical Center, 777 Bannock St, Denver, MC, Colorado, 0188, 80204, USA.
- University of Colorado School of Medicine, Aurora, CO, USA.
- Department of Orthopedics, Physical Medicine & Rehabilitation Ernest E Moore Shock Trauma Center at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA.
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Sheikh SF, Jawade S, Aherrao S, Rohankar A, Gawande I. Exploring Physiotherapeutic Approaches in the Management of Iliac Blade Fractures. Cureus 2024; 16:e69312. [PMID: 39398662 PMCID: PMC11471289 DOI: 10.7759/cureus.69312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 09/12/2024] [Indexed: 10/15/2024] Open
Abstract
One of the leading causes of pelvic fractures, especially iliac blade fractures, is road traffic accidents (RTAs). The orientation of the iliac blade fracture and the associated pelvic instability can provide particular challenges for diagnosis, treatment, and rehabilitation. We hereby, specify a case report of a 17-year-old male suffering from several injuries, including a compound iliac blade fracture, in a high-speed motor vehicle incident. The initial assessment revealed that the pelvic area was found to be painful, swollen, and had limited mobility. Diagnostic imaging such as X-ray evaluation was used to confirm the iliac blade's compound 3B fracture. Conservative procedures comprised of immobilization, medical treatment, and physical therapy. Early mobilization, pain management, and physical therapy to regain pelvic stability and function were all part of the follow-up therapy. The cause of iliac blade fracture in the patient is RTA. The present case report outlines the standardized protocols implemented to improve outcomes associated with iliac blade fractures secondary to RTAs. It emphasizes the significance of effective rehabilitation in the early management of symptoms such as pain and decreased range of motion (ROM), as well as in preventing deformity.
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Affiliation(s)
- Simran F Sheikh
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapna Jawade
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samruddhi Aherrao
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anushka Rohankar
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ishwari Gawande
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Chen Q, Li T, Ding H, Huang G, Du D, Yang J. Age-period-cohort analysis of epidemiological trends in pelvic fracture in China from 1992 to 2021 and forecasts for 2046. Front Public Health 2024; 12:1428068. [PMID: 39040861 PMCID: PMC11260792 DOI: 10.3389/fpubh.2024.1428068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 06/19/2024] [Indexed: 07/24/2024] Open
Abstract
Background This study explored the epidemiological trends in pelvic fracture (PF) in China from 1992 to 2021, analyze their relationships with age-period-cohort (APC) factors, and predict the trends of PF from 2022 to 2046. Methods Incidence and years lived with disabilities (YLDs) of PF among sexes in China from 1992 to 2021 were obtained through the 2021 Global Burden of Disease (GBD) database. Trends in the incidence and YLDs were described, and a joinpoint regression model was used. The APC model was used to explore the effects of age, period, and cohort on the incidence and YLDs. Nordpred forecasted the incidence and YLDs in China from 2022 to 2046. Results In 2021, there were an estimated 0.63 million incidence cases and 0.33 million of YLDs, respectively. The number and age-standardized rate (ASR) of incidence and YLDs were both gradually increased. The average annual percent change (AAPC) in incidence and YLDs for men were 0.26% and -0.17%, respectively. For women, the AAPC values for incidence and YLDs were -0.03% and -0.57% (p < 0. 001), respectively. The relative risk (RR) of PF increases with age, with the lowest risk in those aged 10-14 years for incidence and aged 1-4 for YLDs and the highest risk in those aged >95 years for incidence and aged 90-94 years for YLDs. The period effect showed a totally increase in the risk across the general, male, and female populations. Cohort effects indicated a totally significant decline for both incidence and YLDs. The predicted incidence and YLDs of PF in China from 2022 to 2046 showed an initial rise, followed by a decline, with 2029 and 2034 being the turning point for incidence and YLDs, respectively. Conclusion The characteristics of pelvic fracture incidence and YLDs in China are complex. Thus, primary prevention measures must be strengthened. Raising awareness about osteoporosis prevention, enhancing public health education, and promoting good dietary and hygiene habits are appropriate preventive measures for PF in China.
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Affiliation(s)
- Qingsong Chen
- School of Microelectronics and Communication Engineering of Chongqing University, Chongqing University Central Hospital (Chongqing Emergency Medical Center), Chongqing, China
- Department of Traumatology, National Regional Trauma Medical Center, Chongqing University Central Hospital (Chongqing Emergency Medical Center), Chongqing, China
| | - Tao Li
- Department of Traumatology, National Regional Trauma Medical Center, Chongqing University Central Hospital (Chongqing Emergency Medical Center), Chongqing, China
| | - Hong Ding
- Department of Orthopedics, Chongqing University Central Hospital, Chongqing Emergency Medical Center, Chongqing, China
| | - Guangbin Huang
- Department of Traumatology, National Regional Trauma Medical Center, Chongqing University Central Hospital (Chongqing Emergency Medical Center), Chongqing, China
| | - Dingyuan Du
- Department of Traumatology, National Regional Trauma Medical Center, Chongqing University Central Hospital (Chongqing Emergency Medical Center), Chongqing, China
| | - Jun Yang
- Department of Traumatology, National Regional Trauma Medical Center, Chongqing University Central Hospital (Chongqing Emergency Medical Center), Chongqing, China
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Hasegawa IG, Sakka B, Duong AM, Ding L, Wong MD, Gary JL, Patterson JT. Anterior internal versus external fixation of unstable pelvis fractures was not associated with discharge destination, critical care, length of stay, or hospital charges. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2773-2778. [PMID: 38771369 PMCID: PMC11291563 DOI: 10.1007/s00590-024-03985-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Determine if anterior internal versus supra-acetabular external fixation of unstable pelvic fractures is associated with care needs or discharge. METHODS A retrospective cohort study was performed at two tertiary trauma referral centers. Adults with unstable pelvis fractures (AO/OTA 61B/61C) who received operative fixation of the anterior and posterior pelvic ring by two orthopedic trauma surgeons from October 2020 to November 2022 were included. The primary outcome was discharge destination. Secondary outcomes included intensive care unit (ICU) or ventilator days, length of stay, and hospital charges. RESULTS Eighty-three eligible patients were 38.6% female, with a mean age of 47.2 ± 20.3 years and BMI 28.1 ± 6.4 kg/m2. Fifty-nine patients (71.1%) received anterior pelvis internal fixation and 24 (28.9%) received external fixation. External fixation was associated with weight-bearing restrictions (91.7% versus 49.2%, p = 0.01). No differences in demographic, functional status, insurance type, fracture classification, or injury severity measures were observed by treatment. Internal versus external anterior pelvic fixation was not associated with discharge to home (49.2% versus 29.2%, p = 0.10), median ICU days (3.0 [interquartile range (IQR) 7.8 versus 5.5 [IQR 4.3], p = 0.14, ventilator days (0 [IQR 6.0] versus 0 [IQR 2.8], p = 0.51), length of stay (13.0 [IQR 13.0] versus 17.5 (IQR 20.5), p = 0.38), or total hospital charges (US dollars 180,311 [IQR 219,061.75] versus 243,622 [IQR 187,111], p = 0.14). CONCLUSIONS Anterior internal versus supra-acetabular external fixation of unstable pelvis fractures was not significantly associated with discharge destination, critical care, hospital length of stay, or hospital charges. This sample may be underpowered to detect differences between groups. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Ian G Hasegawa
- Dpeartment of Orthopaedic Surgery, Queens Medical Center, Honolulu, Hawaii, US
| | - Brandan Sakka
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, US
| | - Andrew M Duong
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, US
| | - Li Ding
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, CA, US
| | - Monica D Wong
- Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, US
| | - Joshua L Gary
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, US
| | - Joseph T Patterson
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, US.
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Fokin AA, Wycech Knight J, Tharp ME, Brinton KC, Gallagher PK, Xie JF, Weisz RD, Puente I. Pelvic fractures in blunt trauma patients: A comparative study. World J Orthop 2024; 15:418-434. [PMID: 38835686 PMCID: PMC11145966 DOI: 10.5312/wjo.v15.i5.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/09/2024] [Accepted: 04/23/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Pelvic fractures (PF) with concomitant injuries are on the rise due to an increase of high-energy trauma. Increase of the elderly population with age related comorbidities further complicates the management. Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones. Presence of contrast blush (CB) on computed tomography in patients with PF is considered a sign of active bleeding, however, its clinical significance and association with outcomes is debatable. AIM To analyze polytrauma patients with PF with a focus on the geriatric population, co-injuries and the value of contrast blush. METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center (01/2017-01/2023). Analyzed variables included: Age, sex, mechanism of injury (MOI), injury severity score (ISS), Glasgow coma scale (GCS), abbreviated injury scale (AIS), co-injuries, transfusion requirements, pelvic angiography, embolization, laparotomy, orthopedic pelvic surgery, intensive care unit and hospital lengths of stay, discharge disposition and mortality. The study compared geriatric and non-geriatric patients, patients with and without CB and abdominal co-injuries. Propensity score matching was implemented in comparison groups. RESULTS PF comprised 4% of all trauma admissions. 89 patients had CB. 286 (52%) patients had concomitant injuries including 93 (17%) patients with abdominal co-injuries. Geriatric patients compared to non-geriatric had more falls as MOI, lower ISS and AIS pelvis, higher GCS, less abdominal co-injuries, similar CB and angio-embolization rates, less orthopedic pelvic surgeries, shorter lengths of stay and higher mortality. After propensity matching, orthopedic pelvic surgery rates remained lower (8% vs 19%, P < 0.001), hospital length of stay shorter, and mortality higher (13% vs 4%, P < 0.001) in geriatric patients. Out of 89 patients with CB, 45 (51%) were embolized. After propensity matching, patients with CB compared to without CB had more pelvic angiography (71% vs 12%, P < 0.001), higher embolization rates (64% vs 22%, P = 0.02) and comparable mortality. CONCLUSION Half of the patients with PF had concomitant co-injuries, including abdominal co-injuries in 17%. Similarly injured geriatric patients had higher mortality. Half of the patients with CB required an embolization.
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Affiliation(s)
- Alexander A Fokin
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Charles E Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Joanna Wycech Knight
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Trauma and Critical Care Services, Broward Health Medical Center, Fort Lauderdale, FL 33316, United States
| | - Madison E Tharp
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Kyler C Brinton
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Phoebe K Gallagher
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Justin Fengyuan Xie
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Charles E Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Russell D Weisz
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
| | - Ivan Puente
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Charles E Schmidt College of Medicine, Department of Surgery, Florida Atlantic University, Boca Raton, FL 33431, United States
- Trauma and Critical Care Services, Broward Health Medical Center, Fort Lauderdale, FL 33316, United States
- Herbert Wertheim College of Medicine, Department of Surgery, Florida International University, Miami, FL 33199, United States
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Jensen LR, Possfelt-Møller E, Nielsen AE, Singh UM, Svendsen LB, Penninga L. Accuracy of FAST in detecting intraabdominal bleeding in major trauma with pelvic and/or acetabular fractures: a retrospective cohort study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1479-1486. [PMID: 38253932 PMCID: PMC10980602 DOI: 10.1007/s00590-023-03813-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE The Focused Assessment with Sonography for Trauma (FAST) is a tool to rapidly detect intraabdominal and intrapericardial fluid with point-of-care ultrasound. Previous studies have questioned the role of FAST in patients with pelvic fractures. The aim of the present study was to assess the accuracy of FAST to detect clinically significant intraabdominal hemorrhage in patients with pelvic fractures. METHODS We included all consecutive patients with pelvic and/or acetabular fractures treated our Level 1 trauma center from 2009-2020. We registered patient and fracture characteristics, FAST investigations and CT descriptions, explorative laparotomy findings, and transfusion needs. We compared FAST to CT and laparotomy findings, and calculated true positive and negative findings, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS We included 389 patients. FAST had a sensitivity of 75%, a specificity of 98%, a PPV of 84%, and a NPV of 96% for clinically significant intraabdominal bleeding. Patients with retroperitoneal hematomas were at increased risk for laparotomy both because of True-negative FAST and False-positive FAST. CONCLUSION FAST is accurate to identify clinically significant intraabdominal blood in patients with severe pelvic fractures and should be a standard asset in these patients. Retroperitoneal hematomas challenge the FAST interpretation and thus the decision making when applying FAST in patients with pelvic fractures.
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Affiliation(s)
- Lasse Rehné Jensen
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emma Possfelt-Møller
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Allan Evald Nielsen
- Department of Orthopaedic Surgery, Trauma Section, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Upender Martin Singh
- Department of Orthopaedic Surgery, Trauma Section, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Bo Svendsen
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luit Penninga
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Gottfried A, Gendler S, Chayen D, Radomislensky I, Mitchnik IY, Epshtein E, Tsur AM, Almog O, Talmy T. Hemorrhagic Shock in Isolated and Non-Isolated Pelvic Fractures: A Registries-Based Study. PREHOSP EMERG CARE 2024; 28:589-597. [PMID: 38416869 DOI: 10.1080/10903127.2024.2322014] [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: 10/09/2023] [Accepted: 02/15/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Pelvic fractures resulting from high-energy trauma can frequently present with life-threatening hemodynamic instability that is associated with high mortality rates. The role of pelvic exsanguination in causing hemorrhagic shock is unclear, as associated injuries frequently accompany pelvic fractures. This study aims to compare the incidence of hemorrhagic shock and in-hospital outcomes in patients with isolated and non-isolated pelvic fractures. METHODS Registries-based study of trauma patients hospitalized following pelvic fractures. Data from 1997 to 2021 were cross-referenced between the Israel Defense Forces Trauma Registry (IDF-TR), documenting prehospital care, and Israel National Trauma Registry (INTR) recording hospitalization data. Patients with isolated pelvic fractures were defined as having an Abbreviated Injury Scale (AIS) <3 in other anatomical regions, and compared with patients sustaining pelvic fracture and at least one associated injury (AIS ≥ 3). Signs of profound shock upon emergency department (ED) arrival were defined as either a systolic blood pressure <90 mmHg and/or a heart rate >130 beats per min. RESULTS Overall, 244 hospitalized trauma patients with pelvic fractures were included, most of whom were males (84.4%) with a median age of 21 years. The most common injury mechanisms were motor vehicle collisions (64.8%), falls from height (13.1%) and gunshot wounds (11.5%). Of these, 68 (27.9%) patients sustained isolated pelvic fractures. In patients with non-isolated fractures, the most common regions with a severe associated injury were the thorax and abdomen. Signs of shock were recorded for 50 (20.5%) patients upon ED arrival, but only four of these had isolated pelvic fractures. In-hospital mortality occurred among 18 (7.4%) patients, all with non-isolated fractures. CONCLUSION In young patients with pelvic fractures, severe associated injuries were common, but isolated pelvic fractures rarely presented with profound shock upon arrival. Prehospital management protocols for pelvic fractures should prioritize prompt evacuation and resuscitative measures aimed at addressing associated injuries.
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Affiliation(s)
- Amir Gottfried
- Israel Defense Forces Medical Corps, Surgeon's General Headquarters, Ramat Gan, Israel
| | - Sami Gendler
- Israel Defense Forces Medical Corps, Surgeon's General Headquarters, Ramat Gan, Israel
| | - David Chayen
- Israel Defense Forces Medical Corps, Surgeon's General Headquarters, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Irina Radomislensky
- Israel Defense Forces Medical Corps, Surgeon's General Headquarters, Ramat Gan, Israel
- The National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-HaShomer, Israel
| | - Ilan Y Mitchnik
- Israel Defense Forces Medical Corps, Surgeon's General Headquarters, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Department of Orthopedic Surgery, Shamir Medical Center, Zrifin, Israel
| | - Elad Epshtein
- Israel Defense Forces Medical Corps, Surgeon's General Headquarters, Ramat Gan, Israel
| | - Avishai M Tsur
- Israel Defense Forces Medical Corps, Surgeon's General Headquarters, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Department of Medicine, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Almog
- Israel Defense Forces Medical Corps, Surgeon's General Headquarters, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Tomer Talmy
- Israel Defense Forces Medical Corps, Surgeon's General Headquarters, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Division of Anesthesia, Intensive Care, and Pain, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
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8
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Araki R, Asari T, Fukutoku T, Takeuchi K, Nakamura Y. Early Postoperative Outcomes of Periprosthetic Femoral Fracture in Patients Over 90 Years of Age. Cureus 2024; 16:e57145. [PMID: 38681296 PMCID: PMC11055707 DOI: 10.7759/cureus.57145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
The number of total hip arthroplasty and bipolar hemiarthroplasty is increasing because of their good clinical outcomes and the aging population. Consequently, the incidence of periprosthetic femoral fractures (PFFs) is expected to increase in older patients with osteoporosis. Surgery is the first choice of treatment for PFF, except in Vancouver Type A fractures. However, surgical treatment of PFF, including open reduction and internal fixation (ORIF) and revision arthroplasty, is highly invasive, and high mortality rates have been reported. The indication for ORIF for PFF in very elderly patients at a high risk of complications remains controversial, and postoperative outcomes are uncertain. This study aimed to evaluate the postoperative outcomes of ORIF for PFF in elderly patients. We retrospectively analyzed four females with a mean age of 90.7 years (91-92 years) who underwent ORIF for PFF at our institution from September 2014 to January 2023. No cases of American Society of Anesthesiologists (ASA) grade 3 or higher were found. Three patients were classified as Vancouver Type B1, and one was classified as Vancouver Type C. Cementless stems were used in primary surgeries in all cases. To measure clinical outcomes, we investigated the patient's walking ability at 30 days, three months postoperatively, and the final follow-up. Mortality was assessed during the follow-up period. One patient could walk without walking aids preoperatively, two used a walking stick, and one used a walker. All patients remained hospitalized and underwent gait training with a walker at 30 days follow-up; however, at three months postoperatively and the final follow-up, no patient was unable to walk. No deaths occurred within one month of surgery. Three deaths occurred during follow-up: one within six months, one within one year, and one within five years of surgery. The postoperative ORIF results for PFF in patients aged > 90 years showed no fatal perioperative complications and low mortality within 30 days postoperatively. These results suggest that ORIF for PFF can be considered for elderly patients if the preoperative ASA grade is relatively low.
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Affiliation(s)
- Ryo Araki
- Department of Orthopedic Surgery, Hirosaki General Medical Center, Hirosaki, JPN
| | - Toru Asari
- Department of Orthopedic Surgery, Hirosaki General Medical Center, Hirosaki, JPN
| | - Tatsuhiro Fukutoku
- Department of Orthopedic Surgery, Hirosaki General Medical Center, Hirosaki, JPN
| | - Kazunari Takeuchi
- Department of Orthopedic Surgery, Hirosaki General Medical Center, Hirosaki, JPN
| | - Yoshihide Nakamura
- Department of Orthopedic Surgery, Hirosaki General Medical Center, Hirosaki, JPN
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Ono S, Miyata S, Suzuki H, Shimizu K. Effectiveness of pelvic circumferential compression device for lower body trauma: Insights from a Japan Trauma Data Bank retrospective study. Acute Med Surg 2024; 11:e983. [PMID: 39045517 PMCID: PMC11263733 DOI: 10.1002/ams2.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/25/2024] [Accepted: 07/12/2024] [Indexed: 07/25/2024] Open
Abstract
Aim Pelvic ring fractures (PRFs) due to high-energy trauma often result in severe bleeding and high mortality. Pelvic circumferential compression devices (PCCD) are widely used to stabilize PRF and decrease bleeding. However, evidence supporting their effectiveness is still inconclusive. Methods We conducted an observational study using the Japan Trauma Data Bank (JTDB) from 2019 to 2021. Patients with blunt lower body trauma aged 15 years or older were included. We used propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) to evaluate the association of PCCD and mortality. Results Of the 74,393 patients in the database, 235 PCCD group and 23,429 control group were analyzed. After PSM, 231 patients in both groups were enrolled. Crude analysis indicated significantly higher in-hospital mortality in the PCCD group (odds ratio (OR) = 3.8 [95% CI = 2.51-5.75]). However, PSM and IPTW analysis indicated that PCCD was associated with decreased in-hospital mortality (PSM: OR = 0.79 [0.43-1.42]; IPTW: OR = 0.73 [0.62-0.86]). In a subgroup analysis of the IPTW analysis, PCCD fitting resulted in increased in-hospital mortality in the group without PRF (OR = 2.08 [1.91-2.27]), a decrease in stable PRF (OR = 0.74 [0.6-0.91]), and a further decrease in unstable PRF (OR = 0.18 [0.12-0.27]). Additional factors, such as a fall from a height, a fall downstairs, and pre-hospital PCCD placement also influenced the treatment effect. Conclusion The present, large, registry-based study found that PCCD reduced mortality in patients with a lower body injury, especially those with an unstable PRF.
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Affiliation(s)
- Shohei Ono
- Department of Anesthesiology and Critical Care MedicineJichi Medical University, Saitama Medical CenterSaitamaSaitamaJapan
- Department of Emergency and Intensive Care MedicineTokyo Metropolitan Tama Medical CenterFuchu, TokyoJapan
| | - Satoshi Miyata
- Teikyo University Graduate School of Public HealthItabashi‐ku, TokyoJapan
| | - Hiroaki Suzuki
- Department of Emergency and Intensive Care MedicineTokyo Metropolitan Tama Medical CenterFuchu, TokyoJapan
| | - Keiki Shimizu
- Department of Emergency and Intensive Care MedicineTokyo Metropolitan Tama Medical CenterFuchu, TokyoJapan
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Hao XD, Zhang YZ, Wang SB, Liu G. Unobstructed orthopaedic surgical robot assisted percutaneous iliosacral screw fixation of sacral brittle fractures. Front Med (Lausanne) 2023; 10:1218720. [PMID: 38034536 PMCID: PMC10687396 DOI: 10.3389/fmed.2023.1218720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Pelvic fractures mostly result from high-energy injuries in life; the longitudinal fracture of the sacrum is the most common type of sacrum fracture. This study was designed to evaluate the accuracy, safety, and efficacy of percutaneous sacroiliac joint screw placement in the treatment of longitudinal sacrum fractures with the assistance of unobstructed orthopaedic surgery robots. According to different surgical methods, 32 patients were divided into robot group and free hand group, with 16 patients in each group. The operation time, intra-operative blood loss, intra-operative fluoroscopy times, screw placement angle deviation were collected. There were statistically significant differences in terms of angle deviation of screw placement (1.96 ± 0.75° vs. 2.87 ± 1.03°; p = 0.0145), deviation of the guide needle (1.92 ± 0.93 mm vs. 2.91 ± 1.22 mm; p = 0.0209), intra-operative fluoroscopy time (7.25 ± 1.72 s vs. 20.93 ± 5.64 s; p = 0.0000), insertion time of each sacroiliac joint screw (14.72 ± 2.66 min vs. 29.21 ± 5.18 min; p = 0.0000). There was no statistically significant difference in terms of blood loss (100.21 ± 7.37 mL vs. 102.52 ± 8.15 mL; p = 0.4136). These results suggest that orthopaedic surgery robot for the treatment of longitudinal sacrum fracture is safer and provides less irradiation than the traditional freehand methods.
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Affiliation(s)
- Xiao-dong Hao
- Department of Orthopaedics, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yuan-zhi Zhang
- Department of Orthopaedics, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Shao-bai Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Gang Liu
- Department of Orthopaedics, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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11
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Minici R, Mercurio M, Guzzardi G, Venturini M, Fontana F, Brunese L, Guerriero P, Serra R, Piacentino F, Spinetta M, Zappia L, Costa D, Coppola A, Galasso O, Laganà D. Transcatheter Arterial Embolization for Bleeding Related to Pelvic Trauma: Comparison of Technical and Clinical Results between Hemodynamically Stable and Unstable Patients. Tomography 2023; 9:1660-1682. [PMID: 37736986 PMCID: PMC10514840 DOI: 10.3390/tomography9050133] [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: 07/11/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Endovascular intervention is now the primary line of therapy for arterial injury brought on by pelvic trauma since it can significantly reduce considerable morbidity associated with surgery and can swiftly access and control bleeding sites. Despite international guidelines and widespread awareness of the role of angioembolization in clinical practice, robust evidence comparing the outcomes of angioembolization in hemodynamically stable and unstable patients is still lacking. This study aims to directly compare the outcomes of angioembolization for the treatment of pelvic traumatic arterial injury in patients with hemodynamic stability vs. hemodynamic instability. METHODS In our multicenter retrospective investigation, we analyzed data from consecutive patients who underwent, from January 2020 to May 2023, angioembolization for traumatic pelvic arterial injury. RESULTS In total, 116 angioembolizations were performed. Gelatin sponges (56.9%) and coils (25.9%) were the most widely used embolic agents. The technical and clinical success rates were 100% and 91.4%, respectively. No statistically significant differences were observed between the two groups in terms of technical success, clinical success, procedure-related complication rate, or 30-day bleeding-related mortality. CONCLUSIONS Angioembolization is an effective and safe option for the management of traumatic pelvic arterial lesions even in hemodynamically unstable patients, despite technical variations such as greater use of prophylactic angioembolization.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (L.Z.); (D.L.)
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, Magna Græcia University, Dulbecco University Hospital, 88100 Catanzaro, Italy; (M.M.); (O.G.)
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.F.); (F.P.); (A.C.)
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.F.); (F.P.); (A.C.)
| | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (L.B.); (P.G.)
| | - Pasquale Guerriero
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy; (L.B.); (P.G.)
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.F.); (F.P.); (A.C.)
| | - Marco Spinetta
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Lorenzo Zappia
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (L.Z.); (D.L.)
| | - Davide Costa
- Department of Law, Economics and Sociology, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.F.); (F.P.); (A.C.)
| | - MGJR Research Team
- Magna Graecia Junior Radiologists Research Team, 88100 Catanzaro, Italy;
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, Magna Græcia University, Dulbecco University Hospital, 88100 Catanzaro, Italy; (M.M.); (O.G.)
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (L.Z.); (D.L.)
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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12
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Jo WL, Chung YG, Shin SH, Lim JH, Kim MS, Yoon DK. Structural analysis of customized 3D printed plate for pelvic bone by comparison with conventional plate based on bending process. Sci Rep 2023; 13:10542. [PMID: 37386116 PMCID: PMC10310805 DOI: 10.1038/s41598-023-37433-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023] Open
Abstract
Pelvic bone fracture is highly complex, and its anatomical reduction is difficult. Therefore, patient-specific customized plates have been developed using three-dimensional (3D) printing technology and are being increasingly used. In this study, the reduction status in five representative pelvic fracture models was compared between two groups: the 3D printing plate (3DP) group using a patient-specific 3D printed plate after virtual reduction and the conventional plate (CP) group using a conventional plate by manual bending. The 3DP and CP groups included 10 and 5 cases, respectively. The fractured models were reduced virtually and their non-locking metal plates were customized using 3D printing. The process of contouring the conventional plates to fit the contact surface of the bone with the bending tool was conducted by an experienced pelvic bone trauma surgeon. The reduction and fixation achieved using the two different plate groups was compared, and the significance of differences in the results was analyzed using paired t-tests, after verifying the normality of data distribution. The vertex distances between the surface of the bone and the contact surface of the plate were significantly lower in the 3DP group than in the CP group (0.407 ± 0.342 and 2.195 ± 1.643, respectively, P = 0.008). Length and angular variations, which are measurements of the reduction state, were also lower in the 3DP group than in the CP group (length variation: 3.211 ± 2.497 and 5.493 ± 3.609, respectively, P = 0.051; angular variation: 2.958 ± 1.977 and 4.352 ± 1.947, respectively, P = 0.037). The customized 3D printed plate in the virtual reduction model provided a highly accurate reduction of pelvic bone fractures, suggesting that the customized 3D printed plate may help ensure easy and accurate reduction.
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Affiliation(s)
- Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 222, Banpo-Daero, Seocho-Gu, Korea
| | - Yang-Guk Chung
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 222, Banpo-Daero, Seocho-Gu, Korea.
| | - Seung-Han Shin
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 222, Banpo-Daero, Seocho-Gu, Korea
| | - Jae-Hak Lim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 222, Banpo-Daero, Seocho-Gu, Korea
| | - Moo-Sub Kim
- Industrial R&D Center, KAVILAB Co. Ltd., 06693, Seoul, Republic of Korea
| | - Do-Kun Yoon
- Industrial R&D Center, KAVILAB Co. Ltd., 06693, Seoul, Republic of Korea
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13
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Lawson MM, Peterson DF, Friess DM, Cook MR, Working ZM. Delay of fixation increases 30-day complications and mortality in traumatic pelvic ring injuries. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-023-03589-9. [PMID: 37318555 DOI: 10.1007/s00590-023-03589-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/11/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE While decreased time to fixation in femur fractures improves mortality, it remains unclear if the same relationship exists for pelvic fractures. The National Trauma Data Bank (NTDB) is a data repository for trauma hospitals in the United States (injury characteristics, perioperative data, procedures, 30-day complications), and we used this to investigate early, significant complications after pelvic-ring injuries. METHODS The NTDB (2015-2016) was queried to capture operative pelvic ring injuries in adult patients with injury severity score (ISS) ≥ 15. Complications included medical and surgical complications, as well as 30-day mortality. Multivariable logistic regression was used to investigate the association between days to procedure and complications after adjusting for demographic characteristics and comorbidities. RESULTS 2325 patients met inclusion criteria. 532 (23.0%) sustained complications, and 72 (3.2%) died within the first 30 days. The most common complications were deep vein thrombosis (DVT) (5.7%), acute kidney injury (AKI) (4.6%), and unplanned intensive care unit (ICU) admission (4.4%). In a multivariate analysis, days to procedure was independently significantly associated with complications, with an adjusted odds ratio (95% confidence interval) of 1.06 (1.03-1.09, P < 0.001), best interpreted as a 6% increase in the odds of complication or death for each additional day. CONCLUSION Time to pelvic fixation is a significant and modifiable risk factor for major complications and death. This suggests we should prioritize time to pelvic fixation on trauma patients to minimize mortality and major complications.
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Affiliation(s)
- Michelle M Lawson
- Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Danielle F Peterson
- Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Darin M Friess
- Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Mackenzie R Cook
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Zachary M Working
- Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR, USA.
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14
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Parker W, Despain RW, Bailey J, Elster E, Rodriguez CJ, Bradley M. Military experience in the management of pelvic fractures from OIF/OEF. BMJ Mil Health 2023; 169:108-111. [PMID: 32938710 DOI: 10.1136/bmjmilitary-2020-001469] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Pelvic fractures are a common occurrence in combat trauma. However, the fracture pattern and management within the most recent conflicts, i.e. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), have yet to be described, especially in the context of dismounted complex blast injury. Our goal was to identify the incidence, patterns of injury and management of pelvic fractures. METHODS We conducted a retrospective review on all combat-injured patients who arrived at our military treatment hospital between November 2010 and November 2012. Basic demographics, Young-Burgess fracture pattern classification and treatment strategies were examined. RESULTS Of 562 patients identified within the study time period, 14% (81 of 562) were found to have a pelvic fracture. The vast majority (85%) were secondary to an improvised explosive device. The average Injury Severity Score for patients with pelvic fracture was 31±12 and 70% were classified as open. Of the 228 patients with any traumatic lower extremity amputation, 23% had pelvic fractures, while 30% of patients with bilateral above-knee amputations also sustained a pelvic fracture. The most common Young-Burgess injury pattern was anteroposterior compression (APC) (57%), followed by lateral compression (LC) (36%) and vertical shear (VS) (7%). Only 2% (nine of 562) of all patients were recorded as having pelvic binders placed in the prehospital setting. 49% of patients with pelvic fracture required procedural therapy, the most common of which was placement of a pelvic external fixator (34 of 40; 85%), followed by preperitoneal packing (16 of 40; 40%) and angioembolisation (three of 40; 0.75%). 17 (42.5%) patients required combinations of these three treatment modalities, the majority of which were a combination of external fixator and preperitoneal packing. The likelihood to need procedural therapy was impacted by injury pattern, as 72% of patients with an APC injury, 100% of patients with a VS injury and 25% of patients with an LC injury required procedural therapy. CONCLUSIONS Pelvic fractures were common concomitant injuries following blast-induced traumatic lower extremity amputations. APC was the most common pelvic fracture pattern identified. While procedural therapy was frequent, the majority of patients underwent conservative therapy. However, placement of an external fixator was the most frequently used modality. Considering angioembolisation was used in less than 1% of cases, in the forward deployed military environment, management should focus on pelvic external fixation±preperitoneal packing. Finally, prehospital pelvic binder application may be an area for further process improvement.
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Affiliation(s)
- William Parker
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - R W Despain
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - J Bailey
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - E Elster
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - C J Rodriguez
- Division of Trauma, John Peter Smith Hospital, Fort Worth, Texas, USA
| | - M Bradley
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
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15
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Rovere G, Smakaj A, Perna A, De Mauro D, Are L, Meccariello L, Fidanza A, Erasmo R, Falez F, Maccauro G, Liuzza F. Correlation between traumatic pelvic ring injuries and sexual dysfunctions: a multicentric retrospective study. INTERNATIONAL ORTHOPAEDICS 2023; 47:1407-1414. [PMID: 36930257 DOI: 10.1007/s00264-023-05767-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE Among the functional impairments associated with pelvic ring injuries (PRI), sexual dysfunction (SD) is a common clinical issue. The aim of this study is to investigate correlations between traumatic PRI, genitourinary, and sexual dysfunctions, for a proper multidisciplinary treatment. METHODS We performed an observational, multicentric study, from January 2020 to 2022. We conducted a follow-up after surgery at three, six, 12, and 24 months by measuring the Female Sexual Functioning Index (FSFI), the International Index of Erectile Function (IIEF), the Arizona Sexual Experience Scale (ASEX), the Majeed Score, and the SF-12. Descriptive statistics was conducted on T-test, Whelc's test, and one-way ANOVA which were performed when appropriate. RESULTS A total of 76 patients (mean age 42.17 ± 15 years) were included in the study and allocated into three groups (A, B, and C). Tile A group revealed good sexual outcomes, similar to that of healthy patients. Tile B group demonstrated worsen SD than the previous group. In Tile C group, there was a longer average duration of the orthopaedic surgery when compared to group B. However, in terms of SDs, statistical significance could not be demonstrated between groups C and B. CONCLUSIONS We observed a progressive spontaneous recovery of sexual function, corresponding to each PRI group. Moreover, men classified as B2 had milder SDs than B1 male patients.
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Affiliation(s)
- Giuseppe Rovere
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amarildo Smakaj
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Perna
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Orthopaedics and Traumatology, Fondazione Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Domenico De Mauro
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenzo Are
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Meccariello
- Department Orthopaedics and Traumatology, AORN San Pio, Benevento, Italy
| | - Andrea Fidanza
- Department of Orthopaedics and Traumatology, Santo Spirito Hospital, Pescara, Italy
| | - Rocco Erasmo
- Department of Orthopaedics and Traumatology, Santo Spirito Hospital, Pescara, Italy
| | - Francesco Falez
- Department of Orthopaedics and Traumatology, S. Filippo Neri Hospital, ASL Roma 1, Rome, Italy
| | - Giulio Maccauro
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Liuzza
- Orthopaedic Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy.
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16
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Guimarey Duarte R, Rubio Salvador Á, Alemán Aguilera I, Botella López MC. Two cases of pelvic trauma with survival in the necropolis of Qubbet el-Hawa (Egypt). INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2023; 40:56-62. [PMID: 36543051 DOI: 10.1016/j.ijpp.2022.12.002] [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: 04/26/2022] [Revised: 11/27/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate the presence of a trauma that results in pelvic ring disruption and its clinical implications in two individuals from ancient Egypt. MATERIALS Two complete skeletons of adult women, dated to the Middle Kingdom (c. 1980-1760 BCE), from two tombs in the necropolis of Qubbet el-Hawa (Aswan, Egypt). METHODS The anatomical elements were examined macroscopically in Egypt. RESULTS Unilateral sacroiliac luxation with disruption of the pubic symphysis was detected in both individuals. The presence of an overlapped symphysis was evident in female QH34aa. A healed fracture of the iliopubic ramus are present in female QH122. Antemortem bone alterations in the pelvis demonstrate that they survived the trauma. CONCLUSIONS Pelvic trauma due to a lateral compression was detected in the os coxae. Both women survived but probably had severe sequelae that impaired their quality of life. At least one of them might have received some type of medical treatment. SIGNIFICANCE Both cases shed light on pelvic fractures, their mechanisms of production, and their effects on bone and its functionality, as well as revealing possible associated lesions of soft tissues and vital organs. LIMITATIONS The pelvis, or at least the pubic symphysis, must be well preserved to allow the correct diagnosis of this type of lesion. SUGGESTIONS FOR FURTHER RESEARCH Studies are warranted on the detection of this type of fracture, focusing on the subtle bone changes that indicate its presence. There is also a need to develop methodologies that combine the study of bone and soft tissue alterations.
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Affiliation(s)
- Rosario Guimarey Duarte
- Laboratory of Anthropology, Department of Legal Medicine, Toxicology and Physical Anthropology, Faculty of Medicine, University of Granada, Av. de la Investigación 11, 18016 Granada, Spain.
| | - Ángel Rubio Salvador
- Laboratory of Anthropology, Department of Legal Medicine, Toxicology and Physical Anthropology, Faculty of Medicine, University of Granada, Av. de la Investigación 11, 18016 Granada, Spain; Department of Anthropology, Geography and History, Faculty of Humanities and Educational Sciences, University of Jaén, Campus de las Lagunillas s/n, 23071 Jaén, Spain
| | - Inmaculada Alemán Aguilera
- Laboratory of Anthropology, Department of Legal Medicine, Toxicology and Physical Anthropology, Faculty of Medicine, University of Granada, Av. de la Investigación 11, 18016 Granada, Spain
| | - Miguel C Botella López
- Laboratory of Anthropology, Department of Legal Medicine, Toxicology and Physical Anthropology, Faculty of Medicine, University of Granada, Av. de la Investigación 11, 18016 Granada, Spain
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17
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Kastora SL, Eley J, Kounidas G, Dighero I. Fertility and reproductive outcomes following high-energy pelvic fractures: A systematic review and meta-analysis. Int J Gynaecol Obstet 2023. [PMID: 36605023 DOI: 10.1002/ijgo.14652] [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: 07/21/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is a need to decipher the effect of pelvic fractures (PFs) upon female fertility and live birth rate, as data including treatment regimens in large, unselected populations remain scarce. OBJECTIVES To assess the effect of high energy PFs upon female fertility and live birth rate. SEARCH STRATEGY Literature search for relevant studies was performed up to March 2022 in five databases: Embase, MEDLINE, CAB Abstracts, ClinicalTrials.gov, and Google Scholar. SELECTION CRITERIA Retrospective studies assessing live birth, infertility, and dyspareunia rates following PFs. DATA COLLECTION AND ANALYSIS Data were extracted from studies independently by two authors. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies. MAIN RESULTS A total of 763 female patients of median age 27.8 years (95% CI 22-38 years) were included with median follow up of 5 years. Among PF patients, infertility hazard ratio (HR) 1.18 (95% CI 0.76-1.84, P = 0.47; I2 = 18%) and dyspareunia HR 0.60 (95% CI 0.34-1.08, P = 0.09; I2 = 66%), did not significantly differ from the age-matched literature-reported rates among non-PF patients. CONCLUSIONS No significant differences of live birth, infertility, and dyspareunia rates across patients with PFs were found compared with non-PF counterparts.
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Affiliation(s)
- Stavroula L Kastora
- EGA Institute for Women's Health, University College London, London, UK.,Barnet Hospital, Royal Free NHS Trust, London, UK
| | - Jonathan Eley
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Georgios Kounidas
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
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18
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Pean CA, Thomas HM, Singh UM, DeBaun MR, Weaver MJ, von Keudell AG. Use of a Six-Item Modified Frailty Index to Predict 30-day Adverse Events, Readmission, and Mortality in Older Patients Undergoing Surgical Fixation of Lower Extremity, Pelvic, and Acetabular Fractures. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202301000-00010. [PMID: 36701242 PMCID: PMC9857364 DOI: 10.5435/jaaosglobal-d-22-00286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION This is a retrospective study evaluating the use of a new six-item modified frailty index (MF-6) to predict short-term outcomes of patients receiving surgery for lower extremity fractures. METHODS Patients older than 65 years undergoing open reduction and internal fixation for lower extremity, pelvic, and acetabulum fractures were identified from the American College of Surgeons National Surgical Quality Improvement Program. The MF-6 was calculated by assigning one point for each of six common conditions. Multivariable analysis was used to compare patients with an MF-6 of <3 and ≥3. Outcome measures included complications, mortality, readmission, revision surgery, and length of stay. An area under the curve receiver operator analysis was conducted to compare the MF-6 with MF-5, an existing five-item frailty index. RESULTS Nine thousand four hundred sixty-three patients were included. Patients with an MF-6 of ≥3 were at markedly higher risk of discharge destination other than home (Exp[B] = 2.09), mortality (Exp[B] = 2.48), major adverse events (Exp[B] = 2.16), and readmission (Exp[B] = 1.82). Receiver-operating curve analysis demonstrated an area under the curve of 0.65 for mortality, 0.62 for major adverse events, and 0.62 for discharge destination other than home, all of which outperformed the MF-5. DISCUSSION The MF-6 was correlated with a 30-day postoperative incidence of infectious complications, readmission, and discharge destination. MF-6 scores can be used to risk-stratify patient populations as shifts to value-based care continue to develop.
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Affiliation(s)
- Christian A. Pean
- From the Duke Department of Orthopedic Trauma Surgery, University Health System, Durham, NC (Dr. Pean and Dr. DeBaun); the Harvard Orthopedic Trauma Initiative, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, MA (Thomas, Dr. Weaver, and Dr. von Keudell); the Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (Dr. Singh and Dr. von Keudell), and Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark (Dr. von Keudell)
| | - Hannah M. Thomas
- From the Duke Department of Orthopedic Trauma Surgery, University Health System, Durham, NC (Dr. Pean and Dr. DeBaun); the Harvard Orthopedic Trauma Initiative, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, MA (Thomas, Dr. Weaver, and Dr. von Keudell); the Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (Dr. Singh and Dr. von Keudell), and Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark (Dr. von Keudell)
| | - Upender M. Singh
- From the Duke Department of Orthopedic Trauma Surgery, University Health System, Durham, NC (Dr. Pean and Dr. DeBaun); the Harvard Orthopedic Trauma Initiative, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, MA (Thomas, Dr. Weaver, and Dr. von Keudell); the Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (Dr. Singh and Dr. von Keudell), and Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark (Dr. von Keudell)
| | - Malcolm R. DeBaun
- From the Duke Department of Orthopedic Trauma Surgery, University Health System, Durham, NC (Dr. Pean and Dr. DeBaun); the Harvard Orthopedic Trauma Initiative, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, MA (Thomas, Dr. Weaver, and Dr. von Keudell); the Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (Dr. Singh and Dr. von Keudell), and Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark (Dr. von Keudell)
| | - Michael J. Weaver
- From the Duke Department of Orthopedic Trauma Surgery, University Health System, Durham, NC (Dr. Pean and Dr. DeBaun); the Harvard Orthopedic Trauma Initiative, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, MA (Thomas, Dr. Weaver, and Dr. von Keudell); the Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (Dr. Singh and Dr. von Keudell), and Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark (Dr. von Keudell)
| | - Arvind G. von Keudell
- From the Duke Department of Orthopedic Trauma Surgery, University Health System, Durham, NC (Dr. Pean and Dr. DeBaun); the Harvard Orthopedic Trauma Initiative, Brigham and Women's Hospital/Massachusetts General Hospital, Boston, MA (Thomas, Dr. Weaver, and Dr. von Keudell); the Rigshospitalet, University of Copenhagen, Copenhagen, Denmark (Dr. Singh and Dr. von Keudell), and Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark (Dr. von Keudell)
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19
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Wakefield SM, Giannoudis V, Messori M, Giannoudis PV. Atypical APC-1 pelvic fracture presenting with pelvic instability: successful management with pubic symphysis fusion. BMJ Case Rep 2022; 15:15/12/e252473. [PMID: 36549755 PMCID: PMC9791400 DOI: 10.1136/bcr-2022-252473] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
By definition, anteroposterior (AP) compression type 1 (APC-1) injury is a type of pelvic ring injury, which is widely acknowledged as 'stable'. Unstable forms of this injury are very rare and present a challenge for diagnosis and clinical management. Detailed herein is a man in his early 30s, referred to our institution with a 2-year history of pubic symphysis pain following a road traffic accident. Radiological investigation revealed an unstable APC-1 injury. This was subsequently managed with surgical reconstruction leading to the successful return of the patient to former function and recreational activities.
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Affiliation(s)
- Sophia M Wakefield
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Leeds, UK
| | - Vasileios Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Leeds, UK
| | - Matteo Messori
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Leeds, UK
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20
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Ma Y, Mandell JC, Rocha T, Mendicuti MAD, Weaver MJ, Khurana B. Diagnostic accuracy of pelvic radiographs for the detection of traumatic pelvic fractures in the elderly. Emerg Radiol 2022; 29:1009-1018. [PMID: 36190583 DOI: 10.1007/s10140-022-02090-w] [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: 04/24/2022] [Accepted: 09/22/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE Prompt identification of traumatic pelvic fractures in the elderly is critical to guide clinical management; however, the accuracy of pelvic radiographs is often compromised by multiple factors. The purpose of this study is to examine the diagnostic accuracy of radiographs for the detection of pelvic fractures, with CT as the standard of reference. METHODS A retrospective review was performed of patients ≥ 65 years with traumatic pelvic fractures evaluated with both pelvic radiography and computed tomography (CT) from May 2016 to October 2019. Pelvic fractures were classified into fractures of the pubis, ilium, ischium, sacrum, and acetabulum. All pelvic radiographs were independently reviewed by two emergency radiologists. Original CT reports were utilized for the reference standard. RESULTS 177 patients were included, with a total of 555 fractures. The mean age was 81 years and 68% were female. The most common mechanism of injury was fall (62%), followed by motor vehicle accidents (18%). The most fractured bone was the pubis (314/555 fractures). Global pooled sensitivity for pelvic radiographs in detecting pelvic fractures compared to CT was 48%, with a specificity of 93%. Sensitivity for the detection of pelvic fractures is classified by the following types: pubis 61%, acetabulum 60%, ilium 41%, sacrum 20%, and ischium 17%. Eighteen patients (10%) required surgical fixation. Mortality was 8%. CONCLUSION Pelvic radiographs have low sensitivity in detecting traumatic pelvic fractures. These radiographically occult fractures may be clinically significant as a cause of long-term pain and may require orthopedic consultation and possible surgical management.
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Affiliation(s)
- Yuntong Ma
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Jacob C Mandell
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Tatiana Rocha
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Maria ADuran Mendicuti
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Michael J Weaver
- Department of Orthopedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Bharti Khurana
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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21
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Cuthbert R, Walters S, Ferguson D, Karam E, Ward J, Arshad H, Culpan P, Bates P. Epidemiology of pelvic and acetabular fractures across 12-mo at a level-1 trauma centre. World J Orthop 2022; 13:744-752. [PMID: 36159624 PMCID: PMC9453279 DOI: 10.5312/wjo.v13.i8.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/07/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite motor-vehicle safety advancements and increasingly rigorous workplace safety regulations, trauma/suicide remains the leading cause of death under the age of 45 in the United Kingdom. To promote centralisation of care and optimisation of major trauma outcomes, in 2012 the National Health Service introduced the Trauma Network System. To our knowledge, this is the first study to analyse the epidemiology of pelvic and acetabular trauma over a one-year period at a level-1 trauma centre in the United Kingdom, since nationwide introduction of the Trauma Network System.
AIM To characterize the epidemiology of high-energy pelvic and acetabular fractures over a one-year period at a level-1 trauma centre, and explore both resources required to care for these patients and opportunities for future research and injury prevention initiatives.
METHODS 227 consecutive patients at a level-1 trauma centre with pelvic and acetabular fractures were analysed between December 2017-December 2018. Paediatric patients (< 18 years) and fragility fractures were excluded, leaving 175 patients for inclusion in the study. Statistical analysis was performed using Fisher’s exact test for categorical variables.
RESULTS 72% of pelvic and acetabular fractures occurred in male patients at a median age of 45 years. 15% were the result of a suicide attempt. 48% of patients required pelvic or acetabular surgery, with 38% undergoing further surgery for additional orthopaedic injuries. 43% of patients were admitted to intensive care. The median inpatient stay was 13 days, and the 30- day mortality was 5%. Pelvic ring trauma was more commonly associated with abdominal injury (P = 0.01) and spine fractures (P < 0.001) than acetabular fractures. Vertical shear pelvic ring fractures were associated with falls (P = 0.03) while lateral compression fractures were associated with road traffic accidents (P = 0.01).
CONCLUSION High energy pelvic and acetabular fractures are associated with concomitant orthopaedic fractures (most commonly spine and lower limb), intensive care admission and prolonged inpatient stays. Most pelvic ring injuries secondary to road traffic accidents are lateral compression type, demonstrating the need for future research to drive advancements in lateral impact vehicle safety along with mental health surveillance for those deemed to be potential suicide risks.
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Affiliation(s)
- Rory Cuthbert
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
| | - Samuel Walters
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
| | - David Ferguson
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
| | - Edward Karam
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
| | - Jonathan Ward
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
| | - Homa Arshad
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
| | - Paul Culpan
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
| | - Peter Bates
- Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
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22
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Bott A, Nicol G, Odutola A, Halliday R, Acharya MR, Ward A, Chesser TJS. Long-term patient reported sexual and urological dysfunction in males after operatively treated pelvic ring injuries Do generic outcome measures identify genitourinary health problems? Injury 2022; 53:2139-2144. [PMID: 35246326 DOI: 10.1016/j.injury.2022.01.048] [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] [Received: 09/06/2020] [Revised: 01/03/2022] [Accepted: 01/29/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A consecutive series of 177 male patients, with high energy pelvic ring injuries, were treated operatively in our institution. The purpose of this study was to evaluate long-term sexual and urological dysfunction in these patients using validated disease specific patient reported outcome measures (PROMs), and identify if sexual and urological dysfunction is detectable from generic outcome scores used in the assessment of pelvic ring injury at a minimum of 10 years follow-up (range 10-22). METHODS Surviving patients were contacted to complete validated PROMs to examine genitourinary and global functional outcome. Fifty-two male participants, had a mean age of 44-years-old (range,16-69) and ISS of 17 at time of injury. Mean duration follow-up of 15 years. The primary outcome measures were the Sexual Health Inventory for Men (SHIM) and the Modular Questionnaire for Male Lower Urinary Tract Symptoms (MLUTS). Secondary outcomes were the EQ-5D and Short Form 36. Responses were tested for correlation between generic and disease-specific PROMs and analyzed for association with genitourinary injury and age as risk factors of poor outcome. RESULTS Genitourinary injuries occurred in 7 patients (13%), and ten patients (19%) had documented neurological dysfunction following injury. Satisfactory general functional outcome was reported with EQ-5D-3L VAS score of 71. However, 80% report some level of sexual dysfunction with 37% reporting it as severe. MLUTS mean symptom score was 9 (range, 0 - 26) and bothersomeness score was 21 (range, 0-90). There was poor correlation between urological and sexual dysfunction scores and between the disease specific and generic scores. CONCLUSION In operatively treated pelvic ring injuries, validated disease specific PROMs, (SHIM and MLUTs) identified a significant impact to both sexual and urological patient health, with 37% reporting severe sexual dysfunction. Longstanding sexual and/or urological dysfunction can be a source of significant psychological impact that this study has shown is not identifiable using generic PROMs; EQ-5D-3L and SF-36. To gain a holistic understanding of the functional outcome of patients following a pelvic injury, urological and sexual dysfunction must not be overlooked.
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Affiliation(s)
- Alasdair Bott
- Southmead Hospital, Bristol, BS10 6NB, United Kingdom.
| | - Graeme Nicol
- Ninewells Hospital, Dundee, DD2 1SG, United Kingdom
| | - Adekoyejo Odutola
- Weston General Hospital, Weston-Super-Mare, BS23 4TQ, United Kingdom
| | - Ruth Halliday
- North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 6NB, United Kingdom
| | - Mehool R Acharya
- Department of Pelvic and Acetabular Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, United Kingdom
| | - Anthony Ward
- Department of Pelvic and Acetabular Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, United Kingdom
| | - Timothy J S Chesser
- Department of Pelvic and Acetabular Surgery, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, United Kingdom
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23
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Furugori S, Abe T, Funabiki T, Sekikawa Z, Takeuchi I. Arterial embolization for trauma patients with pelvic fractures in emergency settings: A nationwide matched cohort study in Japan. Eur J Vasc Endovasc Surg 2022; 64:234-242. [DOI: 10.1016/j.ejvs.2022.05.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/04/2022] [Accepted: 05/29/2022] [Indexed: 11/03/2022]
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24
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Li PH, Hsu TA, Kuo YC, Fu CY, Bajani F, Bokhari M, Mis J, Poulakidas S, Bokhari F. The application of the WSES classification system for open pelvic fractures-validation and supplement from a nationwide data bank. World J Emerg Surg 2022; 17:29. [PMID: 35624457 PMCID: PMC9145531 DOI: 10.1186/s13017-022-00434-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Open pelvic fractures are rare but complex injuries. Concomitant external and internal hemorrhage and wound infection-related sepsis result in a high mortality rate and treatment challenges. Here, we validated the World Society Emergency Society (WSES) classification system for pelvic injuries in open pelvic fractures, which are quite different from closed fractures, using the National Trauma Data Bank (NTDB). Methods Open pelvic fracture patients in the NTDB 2015 dataset were retrospectively queried. The mortality rates associated with WSES minor, moderate and severe injuries were compared. A multivariate logistic regression model (MLR) was used to evaluate independent factors of mortality. Patients with and without sepsis were compared. The performance of the WSES classification in the prediction of mortality was evaluated by determining the discrimination and calibration. Results A total of 830 open pelvic fracture patients were studied. The mortality rates of the mild, moderate and severe WSES classes were 3.5%, 11.2% and 23.8%, respectively (p < 0.001). The MLR analysis showed that the presence of sepsis was an independent factor of mortality (odds of mortality 9.740, p < 0.001). Compared with patients without sepsis, those with sepsis had significantly higher mortality rates in all WSES classes (minor: 40.0% vs. 3.1%, p < 0.001; moderate: 50.0% vs. 9.1%, p < 0.001; severe: 66.7% vs. 22.2%, p < 0.001). The receiver operating characteristic (ROC) curve showed an acceptable discrimination of the WSES classification alone for evaluating the mortality of open pelvic fracture patients [area under curve (AUC) = 0.717]. Improved discrimination with an increased AUC was observed using the WSES classification plus sepsis (AUC = 0.767). Conclusions The WSES guidelines can be applied to evaluate patients with open pelvic fracture with accurate evaluation of outcomes. The presence of sepsis is recommended as a supplement to the WSES classification for open pelvic fractures.
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Affiliation(s)
- Pei-Hua Li
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Ting-An Hsu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Yu-Chi Kuo
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan. .,Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA.
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
| | - Marissa Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
| | - Justin Mis
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, 8th floor, 1950 West Polk Street, Chicago, IL, 60612, USA
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25
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Chen JP, Tsai PJ, Su CY, Tseng IC, Chou YC, Chen IJ, Lee PW, Yu YH. Percutaneous iliosacral screw and trans-iliac trans-sacral screw with single C-arm fluoroscope intensifier is a safe treatment for pelvic ring injuries. Sci Rep 2022; 12:368. [PMID: 35013494 PMCID: PMC8748721 DOI: 10.1038/s41598-021-04351-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/14/2021] [Indexed: 11/10/2022] Open
Abstract
To elucidate the accuracy, efficacy, and safety of percutaneous iliosacral screw (ISS) and trans-iliac trans-sacral screw (TITS) insertion using a single C-arm fluoroscopy intensifier. Additionally, the potential risk factors that might cause mal-positioned screws were identified. Patients with pelvic ring injuries who underwent percutaneous screw fixation in a single medical institute were divided into an ISS group (n = 59) and a TITS group (n = 62) and assessed. The angles deviated from ideal orientation (ADIO) of the implanted screw were measured, and potential risk factors for mal-positioned screws were analyzed. Overall, the reduction quality of the pelvic ring was good or excellent in 70 patients (82.4%) by Matta’s criteria and in 48 patients (56.5%) by Lefaivre’s criteria. ADIO measurements of the ISS and TITS groups via multi-planar computed tomography were 9.16° ± 6.97° and 3.09° ± 2.8° in the axial view, respectively, and 5.92° ± 3.65° and 2.10° ± 2.01° in the coronal view, respectively. Univariate statistical analysis revealed body mass index as the single potential risk factor of mal-positioned screws. With careful preoperative planning and intraoperative preparations, placing ISS and TITS under the guidance of single C-arm fluoroscopy intensifier is a reliable and safe technique. Caution should be exercised when performing this procedure in patients with a high body mass index.
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Affiliation(s)
- Jui-Ping Chen
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333423, Taiwan
| | - Ping-Jui Tsai
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333423, Taiwan
| | - Chun-Yi Su
- Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, No. 201, Maijin Rd., Anle Dist., Keelung City, 204011, Taiwan
| | - I-Chuan Tseng
- Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial Hospital, No. 123, Dinghu Rd., Guishan Dist., Taoyuan City, 333008, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333423, Taiwan
| | - I-Jung Chen
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333423, Taiwan
| | - Pai-Wei Lee
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333423, Taiwan
| | - Yi-Hsun Yu
- Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333423, Taiwan.
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Usman M, Tarar MY, Toe KKZ, Iqbal M, Kempanna V, Gill I. Evolving Practice in Management of Pelvic-Acetabular Trauma: COVID-19 Experience From a Tertiary Referral Centre in the UK. Cureus 2021; 13:e18778. [PMID: 34796067 PMCID: PMC8590463 DOI: 10.7759/cureus.18778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction The United Kingdom was one of the hardest-hit countries during the COVID-19 Pandemic. The UK government announced three national lockdowns to control the spread of the coronavirus and prevent the NHS from getting overburdened with COVID-19 related attendances. Two of the most significant peaks in terms of COVID-19 related hospitalizations and COVID-19 related deaths were in Summer 2020 (corresponding to lockdown 1, which was in effect from 26th March to 26th May 2020) and early 2021 (corresponding to lockdown 3, which was in effect 6th January to 8th March 2021). During this time, a significant proportion of NHS resources was being diverted towards the treatment of COVID-19 patients. Measures were being taken to prevent unnecessary hospitalizations and reduce patient contact. These included but were not limited to measures to reduce attendances to Emergency departments, introducing telemedicine clinics, and pausing elective services. Our hospital is a Major Trauma Centre providing Tertiary Pelvic trauma service to the Greater Manchester area and the North West of England. We conducted this retrospective comparative study to compare the trends in presentation and Management of Pelvic trauma and identify trends in how these changed throughout the pandemic. We want to share these insights with our readers. Methodology We conducted a retrospective comparative study by comparing two cohorts of patients, patients presenting to the Pelvic Trauma service during Lockdown 1 and Lockdown 3 in the UK, named Group A and Group B, respectively. Data on patient demographics, injuries, and their management was identified from the Electronic Patient Record System. The data analysis was carried out with the aid of Stata/IC version 16.1. using descriptive Statistics. Results Group A contained 19 patients, with a mean age of 66.9 years. Group B contained 23 patients with a mean age of 67.4 years. There was no statistically significant difference in these patients' population demographics, injury patterns, and management (operative vs conservative). However, there was an absolute reduction in the complication rate from Group A to Group B of 17.2% (26.3% vs 9.1%). The higher complication rate during Lockdown 1 can be explained by conservatively managing Pelvic and Acetabular Fractures that would have been eligible for fixation, had COVID-19 not been a factor. Conclusions Within the limitations of our study, it appears that operatively managing a carefully selected cohort of acute Pelvic Trauma patients with proper precautions was safe and effective. It is unclear whether there was an added benefit to having a higher threshold to operate and adopting the watch-and-wait policy in Lockdown 1. We recommend continuing to follow the current evidence and fix these fractures early.
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Affiliation(s)
- Muhammad Usman
- Trauma and Orthopaedics, Salford Royal NHS Foundation Trust, Manchester, GBR
| | | | - Ko Ko Zayar Toe
- Trauma and Orthopaedics, Salford Royal NHS Foundation Trust, Manchester, GBR
| | - Mohammad Iqbal
- Trauma and Orthopaedics, Salford Royal NHS Foundation Trust, Manchester, GBR
| | - Vijaya Kempanna
- Trauma and Orthopaedics, Salford Royal NHS Foundation Trust, Manchester, GBR
| | - Inder Gill
- Trauma and Orthopaedics, Salford Royal NHS Foundation Trust, Manchester, GBR
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Efendiyeva E, Messova A, Myssayev A, Tlemissov A, Muratoglu M, Zhunussov Y. Epidemiology Of Pelvic Ring Fractures and Injuries: A Retrospective Study. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Despite relatively rare occurrence in trauma victims, pelvic fractures have a high risk of mortality and morbidity.
AIM: This study was conducted to study epidemiology of patients with pelvic ring injuries in a level 1 trauma center in Kazakhstan.
METHODS: This is a descriptive cross-sectional study within a single institution. In the period of 2014–2017, we encountered 212 patients with pelvic fractures. About 92% of them had concomitant injures due to a high-energy trauma. Measures were compared using the SPSS 20.0 program.
RESULTS: The mean age was 34.5. Pelvic fractures are more often verified in males. The most common mechanism of injury was road traffic injuries and falls from heights. The highest recovery rates were observed for type B fractures, but mortality was highest for type C fractures. The average length of hospital stay was 18.71 days. Non-surgical treatment was used in 62.3% of patients, external fixation device was imposed as an emergency intervention in 64.2% (n = 136) of patients.
CONCLUSIONS: Overall most patients with pelvic fractures had multiple injuries and the mortality rate was 7.1%. Non-surgical treatment was most commonly used. Type C fractures had significantly fatal outcome.
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28
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Resuscitative endovascular balloon occlusion of the aorta in pelvic ring fractures: The Denver Health protocol. Injury 2021; 52:2702-2706. [PMID: 32057458 DOI: 10.1016/j.injury.2020.01.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 02/02/2023]
Abstract
Patients presenting with hemodynamic instability associated with pelvic fractures continue to have very high mortality and surgeons continue to seek damage control strategies that may improve survival. Strategies usually require massive transfusion, immediate pelvic stabilization and another adjunctive maneuver's such as angioembolization or preperitoneal pelvic packing to prevent hemorrhagic death. One current intervention that has regained some popularity in lieu of resuscitative thoracotomy is the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). This requires some manner of femoral arterial access to insert a balloon into the aorta and increase central blood pressure (cardiac and cerebral perfusion) and control active pelvic bleeding. Based on several animal models and an increasing number of publications, many US level I trauma centers have now opted to use REBOA in carefully selected patients showing signs of near cardiac arrest from non-compressible torso hemorrhage. Description of the current advances in aortic occlusion using catheter-based technology in the setting of severe shock for non-compressible torso hemorrhage from pelvic ring fracture is the purpose of this report.
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29
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Bayrak A, Duramaz A. Erectile Dysfunction after Conservative Treatment of Sacral Fractures in Males without Injury to the Urinary System. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2021; 161:154-159. [PMID: 34544164 DOI: 10.1055/a-1611-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND This study aimed to determine the incidence of erectile dysfunction (ED) reported by patients, and to define the prognostic relationship between ED and conservatively treated sacral fracture without urethral injury. METHODS Patients aged between 20 - 50 years who were sexually active and had no known sexual dysfunction prior to the trauma were included in the study. Seventy-seven patients (47 married, 30 single) treated conservatively for sacral fracture between April 2012 and February 2017 were retrospectively screened. Patients were compared in terms of age, marital status, body mass index (BMI), trauma mechanism, additional system injury, functional outcomes, and complications. Functional outcomes were assessed using the International Index of Erectile Function (IIEF-5) and the Majeed pelvic fracture functional assessment scale (MPS). RESULTS No statistically significant difference was observed between fracture types with respect to age, BMI, follow-up, marital status, trauma mechanism, and accompanying injury. The incidence of ED was 27.3% for those that received conservative treatment after sacrum fracture. The mean score of IIEF-5 was 18.6 ± 6.6 and MPS was 77.2 ± 13.2. There was no significant relationship between the injury type of the patients and the IIEF-5 and MPS scores (p = 0.593 and p = 0.907, respectively). The lowest IIEF-5 score was found in Denis type 2 fractures (p = 0.020). CONCLUSION The frequency of ED was higher in Denis type 2 sacrum fractures. Sexual function should be questioned in the follow-up, especially in those fracture types.
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Affiliation(s)
- Alkan Bayrak
- Orthopedics and Traumatology, Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Altug Duramaz
- Orthopedics and Traumatology, Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Istanbul, Turkey
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Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2687-2697. [PMID: 34378143 PMCID: PMC8514382 DOI: 10.1007/s00264-021-05153-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/17/2021] [Indexed: 11/05/2022]
Abstract
Introduction Pelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. The aim of the present study is to perform a systematic literature review on male and female sexual dysfunctions related to traumatic lesions of the pelvic ring. Methods Scopus, Cochrane Library MEDLINE via PubMed, and Embase were searched using the keywords: “Pelvic fracture,” “Pelvic Ring Fracture,” “Pelvic Ring Trauma,” “Pelvic Ring injury,” “Sexual dysfunction,” “Erectile dysfunction,” “dyspareunia,” and their MeSH terms in any possible combination. The following questions were formulated according to the PICO (population (P), intervention (I), comparison (C), and outcome (O)) scheme: Do patients suffering from pelvic fracture (P) report worse clinical outcomes (C), in terms of sexual function (O), when urological injury occurs (I)? Is the sexual function (O) influenced by the type of fracture (I)? Results After screening 268 articles by title and abstract, 77 were considered eligible for the full-text analysis. Finally 17 studies that met inclusion criteria were included in the review. Overall, 1364 patients (902 males and 462 females, M/F ratio: 1.9) suffering from pelvic fractures were collected. Discussion Pelvic fractures represent challenging entities, often concomitant with systemic injuries and subsequent morbidity. Anatomical consideration, etiology, correlation between sexual dysfunction and genitourinary lesions, or pelvic fracture type were investigated. Conclusion There are evidences in the literature that the gravity and frequency of SD are related with the pelvic ring fracture type. In fact, patients with APC, VS (according Young-Burgess), or C (according Tile) fracture pattern reported higher incidence and gravity of SD. Only a week association could be found between GUI and incidence and gravity of SD, and relationship between surgical treatment and SD. Electrophysiological tests should be routinely used in patient suffering from SD after pelvic ring injuries.
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Armbruster M, Seidensticker M. [Interventional radiology as emergency treatment for pelvic injuries]. Unfallchirurg 2021; 124:627-634. [PMID: 34283262 DOI: 10.1007/s00113-021-01045-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Abstract
CLINICAL ISSUE Pelvic arterial bleeding constitutes a potentially life-threatening event, which can be difficult to control with surgical procedures alone, especially in the case of ligamentous ruptures and a subsequently increased pelvic volume. STANDARD RADIOLOGICAL PROCEDURES Using angiography and embolization (AE) with resorbable gelatine-based particles or permanent coils, plugs, liquid embolic systems or by vascular stenting, in most cases traumatic pelvic arterial bleeding can be stopped and can also be used to close pseudoaneurysms, arteriovenous fistulas or dissections. METHODOLOGICAL INNOVATION AND EVALUATION The AE has become established as a fast and effective minimally invasive procedure in the treatment of traumatic pelvic vascular injuries with an advantageous risk-benefit ratio. PRACTICAL RECOMMENDATIONS An interdisciplinary approach should be used in the indications for AE; which can be used as definitive treatment as well as in combination with surgical procedures. To improve the clinical outcome any delay between establishing the indications and the start of the intervention must be avoided.
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Affiliation(s)
- Marco Armbruster
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
| | - Max Seidensticker
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
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Ferede B, Ayenew A, Belay W. Pelvic Fractures and Associated Injuries in Patients Admitted to and Treated at Emergency Department of Tibebe Ghion Specialized Hospital, Bahir Dar University, Ethiopia. Orthop Res Rev 2021; 13:73-80. [PMID: 34140815 PMCID: PMC8203598 DOI: 10.2147/orr.s311441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Pelvic fractures are high-risk injuries that require careful evaluation due to significant patient morbidity and mortality associated with damage to major blood vessels, nerves, and organs. Thus, the aim of this study was to assess pelvic fractures and associated injuries among patients presented at the emergency department of Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia. Methods This is a cross-sectional study with a retrospective facility-based data collection technique. All patients who were managed for pelvic fracture from September 2018 to February 2021 were included. The patient’s chart number was collected from the orthopedics surgery morning register sheet and their case folders were retrieved from the medical record department. We used a structured and pretested checklist, and chart review for data collection. The collected data were cleaned, coded, and entered into Epi Info version 7 and exported to SPSS version 24 for analysis. Binary logistic regression analysis was used to identify factors associated with a pelvic fracture. Results We studied 64 cases of pelvic fracture during the study period. Pelvic was common among males with a ratio of 7:1 and young population (15–35 years). The most common associated injuries were lower extremity 23 (35.9%), abdominal injuries 16 (25.0%), and urethral injury in 13 (20.3%). Moreover, most patients with pelvic fracture have Tile A fracture 56.3%, Tile C in 20 (31.3%), and Tile B in 8 (12.5%) patients. The road traffic accident was the most common cause of pelvic fracture in 56.3%, followed by fall down accident (28.1%), and bullet injury (12.5%). Conclusion The incidence of pelvic fracture was high in the study area. It reflects the need for strong and multi-sectoral collaboration to prevent pelvic fracture. Additionally, it needs a careful, systematic management approach for survival, healing, and to address the associated complexities and the polytrauma nature.
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Affiliation(s)
- Biruk Ferede
- Department of Orthopedics and Traumatology, Bahir Dar University, College of Medicine and Health Science, Bahir Dar, Ethiopia
| | - Asteray Ayenew
- Department of Midwifery, Bahir Dar University, College of Medicine and Health Science, Bahir Dar, Ethiopia
| | - Worku Belay
- Department of Orthopedics and Traumatology, Bahir Dar University, College of Medicine and Health Science, Bahir Dar, Ethiopia
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Henstenburg JM, Larwa JA, Williams CS, Shah MP, Harding SP. Risk factors for complications following pelvic ring and acetabular fractures: A retrospective analysis at an urban level 1 trauma center. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/22104917211006890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Pelvic ring and acetabular fractures are some of the most morbid in orthopedic trauma. They commonly require large exposures for fixation and are associated with significant morbidity and mortality. This study attempts to identify risk factors for complications following operative fixation of pelvic injuries. Methods: 126 patients treated for pelvic injuries were reviewed retrospectively. Demographics, procedure characteristics, and outcomes were recorded. Variables associated with complications were analyzed using logistic regression analysis. Results: Complications occurred in 12 patients. Higher BMI, longer length of stay, and ilioinguinal approach were significantly associated with increased infection risk. Co-morbid heart disease and concurrent smoking status showed a trend for increased infection risk. Higher BMI and ilioinguinal approach were significantly associated with an increased likelihood of re-operation. Positive psychiatric history and Medicaid payer status showed a trend toward higher reoperation risk. Conclusion: Knowledge of these risk factors can help guide management and predict outcomes following pelvic fracture fixation.
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Affiliation(s)
- Jeffrey M Henstenburg
- Rothman Orthopaedic Institute at Jefferson Health Department of Orthopaedic Surgery, Philadelphia, PA, USA
| | - Joseph A Larwa
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | | | - Susan P Harding
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Höch A, Özkurtul O, Hammer N, Heinemann A, Tse R, Zwirner J, Henkelmann J, Fakler J, Ondruschka B. A comparison on the detection accuracy of ante mortem computed tomography vs. autopsy for the diagnosis of pelvic ring injury in legal medicine. J Forensic Sci 2021; 66:919-925. [PMID: 33512022 DOI: 10.1111/1556-4029.14677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
A detailed knowledge on the exact morphology of pelvic injuries provided crucial information in understanding the mechanisms of injury and has influence on the natural course and subsequent mortality. However, forensic medical literature investigating pelvic fractures in detail is scarce to date. This case series aims to compare the accuracy in detecting pelvic injuries using autopsy and ante mortem computed tomography (CT). Nineteen deceased patients with CT scans of pelvic fractures were included retrospectively. Pelvic injuries were independently assessed by a board-certified radiologist (R) and a board-certified trauma surgeon (T), both using the ante mortem CT scans, and by a board-certified forensic pathologist using autopsy (A) results without knowledge of the CT scan findings. No patient had died causatively from a pelvic fracture. Most injuries of the pelvis were present in the pubic rami (16/18) and sacral bone (13/18), followed by the sacroiliac joint (9/18) and iliac bone fractures (8/18). Ilium fractures (A:100%;R:67%;T:67%) and injuries of the sacroiliac joint (A:83%;R:50%;T:42%) were best detected via autopsy. The diagnosis of sacral fractures (A:19%;R:94%;T:88%) and fractures of the pubic rami (A:67%;R:96%;T:96%) were most often missed in autopsy. The results show deficits in the assessment of the pelvic injury for both CT and autopsy. Autopsy was superior in detecting injuries of the sacroiliac joint, but inferior in detecting sacral and pubic bone fractures. For an encompassing evaluation of ligamento-skeletal pelvic injuries, the complementary use of both CT and autopsy is recommended.
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Affiliation(s)
- Andreas Höch
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Orkun Özkurtul
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Niels Hammer
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.,Department of Macroscopic and Clinical Anatomy, Medical University of Graz, Graz, Austria
| | - Axel Heinemann
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rexson Tse
- Department of Forensic Pathology, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Johann Zwirner
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| | - Jeanette Henkelmann
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Johannes Fakler
- Department of Orthopedic, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Legal Medicine, University Hospital Leipzig, Leipzig, Germany
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Perumal R, S DCR, P SS, Jayaramaraju D, Sen RK, Trikha V. Management of pelvic injuries in hemodynamically unstable polytrauma patients - Challenges and current updates. J Clin Orthop Trauma 2021; 12:101-112. [PMID: 33716435 PMCID: PMC7920327 DOI: 10.1016/j.jcot.2020.09.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/26/2020] [Accepted: 09/28/2020] [Indexed: 12/30/2022] Open
Abstract
Pelvic injuries are notorious for causing rapid exsanguination, and also due to concomitant injuries and complications, they have a relatively higher mortality rate. Management of pelvic fractures in hemodynamically unstable patients is a challenging task and has been variably approached. Over the years, various concepts have evolved, and different guidelines and protocols were established in regional trauma care centers based mainly on their previous experience, outcomes, and availability of resources. More recently, damage control resuscitation, pelvic angioembolization, and acute definitive internal fixation are being employed in the management of these unstable injuries, without clear consensus or guidelines. In this background, we have performed a computerized search using the Cochrane Database of Systematic Reviews, Scopus, Embase, Web of Science, and PubMed databases on studies published over the past 30 years. This comprehensive review aims to consolidate available literature on the current epidemiology, diagnostics, resuscitation, and management options of pelvic fractures in polytraumatized patients with hemodynamic instability with particular focus on damage control resuscitation, pelvic angioembolization, and acute definitive internal fixation.
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Affiliation(s)
- Ramesh Perumal
- Department of Orthopedics and Trauma, Ganga Hospital, Coimbatore, 641043, India
| | | | - Sivakumar S. P
- Department of Orthopedics and Trauma, Ganga Hospital, Coimbatore, 641043, India
| | | | - Ramesh Kumar Sen
- Institute of Orthopedic Surgery, Max Super Specialty Hospital, Mohali, 160055, India
| | - Vivek Trikha
- Department of Orthopedics, All India Institute of Medical Science, New Delhi, 110029, India
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Abstract
BACKGROUND The timing of definitive surgical stabilization is a controversial topic of pelvic and acetabular fracture (PAF) management. Historically, staged care with delayed definitive fixation was recommended; however, more recently, some centers have shown early definitive fixation to be feasible in most patients. We hypothesized that time to definitive fixation of PAF decreased without adverse outcomes. METHODS A level 1 trauma center's prospective pelvic fracture database was retrospectively analyzed. A total of 341 of the 1,270 consecutive PAF patients had surgery between January 2009 and December 2018. Demographics, polytrauma status, hemodynamic stability, time to definitive operation, length of intensive care unit stay, hospital length of stay, mortality were recorded. Data is presented as mean ± SD, percentages. Statistical significance was determined at p < 0.05. RESULTS There were 34 ± 8 per year operatively treated PAF patients during the study period. The demographics (age, 44.1 ± 18 years; 74.5% males) and injury severity (Injury Severity Score, 20; interquartile range, 16-29) did not change. Time to definitive fixation on average was 85 ± 113 hours (range, 0.8-1286 hours). Linear regression analysis demonstrated a decrease in time to definitive fixation considering all patients (β = -0.186, p = 0.003). pelvic ring fractures with polytrauma (β = -1.404, p = 0.03). and hemodynamically unstable patients (β = -1.428, p = 0.037). There was no significant change in mortality, length of stay, or intensive care unit length of stay for the overall cohort or any subgroup. CONCLUSION Time to definitive fixation in PAF has decreased during the last decade, with the largest decrease in time to fixation occurring in the hemodynamically unstable and pelvic fracture with polytrauma cohorts. The timely definitive internal fixation is achievable without increased length of stay. LEVEL OF EVIDENCE Therapeutic/care management, level IV.
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37
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Hossain A, Islam S, Haque Qasem MF, Faisal Eskander SM, Hasan MT, Nahar M. Epidemiology of pelvic fractures in adult: Our experience at two tertiary care hospital in Dhaka, Bangladesh. J Clin Orthop Trauma 2020; 11:1162-1167. [PMID: 33192024 PMCID: PMC7656477 DOI: 10.1016/j.jcot.2020.10.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE In Bangladesh the incidence of pelvic fracture is increasing day by day due to suboptimal roads and heavy traffic. However, there is no epidemiological study of these injuries in Bangladesh. Our aim was to study the epidemiology of patients admitted with pelvic fractures at two tertiary care hospital in Dhaka, Bangladesh. METHODS This was a prospective study carried out on trauma patients with pelvic fracture at two level 1 trauma care center of two tertiary care hospital in Dhaka, Bangladesh. The study period was from July 2015 to June 2019 (48 months). Patient's data including demography of patients, mechanism of injuries, fracture types, associated injuries, method of treatment, post-operative complications, length of hospital stay were recorded according to a unified protocol. RESULTS The study population was comprised of 696 patients, where 556 (79.88%) were male and 140 (20.12%) were female. Mean age was 37.75 years and road traffic accidents were the most common mode of injuries. Lateral compression fractures were the most common injuries and Urethral injuries were the most common associated injuries. Death was the outcome in 3.5% of the cases due to high energy trauma. CONCLUSION This study revealed that pelvic fractures were significantly more frequent in men. Most frequent cause was road traffic accident. The majority of these cases did not required surgery. Mortality was associated with high velocity trauma with severe injuries.
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Affiliation(s)
- Amjad Hossain
- Department of Orthopedics, Lab-aid Hospital, Bangladesh
| | - Saidul Islam
- Department of Orthopedics, Dhaka Medical College Hospital, Bangladesh
| | | | | | | | - Munmun Nahar
- Department of Oral and Maxillofacial Surgery, Dhaka Dental College Hospital, Bangladesh
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Okada Y, Nishioka N, Ohtsuru S, Tsujimoto Y. Diagnostic accuracy of physical examination for detecting pelvic fractures among blunt trauma patients: a systematic review and meta-analysis. World J Emerg Surg 2020; 15:56. [PMID: 33008428 PMCID: PMC7531119 DOI: 10.1186/s13017-020-00334-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Pelvic fractures are common among blunt trauma patients, and timely and accurate diagnosis can improve patient outcomes. However, it remains unclear whether physical examinations are sufficient in this context. This study aims to perform a systematic review and meta-analysis of studies on the diagnostic accuracy and clinical utility of physical examination for pelvic fracture among blunt trauma patients. METHODS Studies were identified using the MEDLINE, EMBASE, and CENTRAL databases starting from the creation of the database to January 2020. A total of 20 studies (49,043 patients with 8300 cases [16.9%] of pelvic fracture) were included in the quality assessment and meta-analysis. Two investigators extracted the data and evaluated the risk of bias in each study. The meta-analysis involved a hierarchical summary receiver operating curve (ROC) model to calculate the diagnostic accuracy of the physical exam. Subgroup analysis assessed the extent of between-study heterogeneity. Clinical utility was assessed using decision curve analysis. RESULTS The median prevalence of pelvic fracture was 10.5% (interquartile range, 5.1-16.5). The pooled sensitivity (and corresponding 95% confidence interval) of the hierarchical summary ROC parameters was 0.859 (0.761-0.952) at a given specificity of 0.920, which was the median value among the included studies. Subgroup analysis revealed that the pooled sensitivity among patients with a Glasgow Coma Scale score ≥ 13 was 0.933 (0.847-0.998) at a given specificity of 0.920. The corresponding value for patients with scores ≤ 13 was 0.761 (0.560-0.932). For threshold probability < 0.01 with 10-15% prevalence, the net benefit of imaging tests was higher than that of physical examination. CONCLUSION Imaging tests should be performed in all trauma patients regardless of findings from physical examination or patients' levels of consciousness. However, the clinical role of physical examination should be considered given the prevalence and threshold probability in each setting.
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Affiliation(s)
- Yohei Okada
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Shogoin Kawaramachi 54, Sakyo, Kyoto, 606-8507, Japan.
- Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan.
| | - Norihiro Nishioka
- Department of Preventive Services, School of Public Health, Kyoto University, Kyoto, Japan
| | - Shigeru Ohtsuru
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Shogoin Kawaramachi 54, Sakyo, Kyoto, 606-8507, Japan
| | - Yasushi Tsujimoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Nephrology and Dialysis, Kyoritsu Hospital, Osaka, Japan
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Abstract
EPIDEMIOLOGY Traumatic fractures of the pelvic ring are relatively rare, but are associated with increased risk of mortality. Depending on injury mechanism and main vector of energy impact, a distinction is made between anteroposterior compression, lateral compression, and vertical shear (Young and Burgess classification), while the stability-related classification according to Tile distinguishes between type A (stable), type B (rotationally unstable) and type C (completely unstable). A comprehensive modern classification is given by the AO/OTA. RADIOLOGICAL FRACTURE DIAGNOSIS Plain pelvis x‑rays lack sufficient sensitivity but are still used to detect highly unstable pelvic fractures. CT has superior sensitivity and specificity. In addition to fracture classification, CT allows reliable assessment of associated vascular and bladder/urethral injuries and large soft tissue hemorrhage. MRI is unparalleled in showing bone marrow edema, cauda and plexus complications, and peripelvic soft tissue damage. MRI may also prove to be a valuable diagnostic tool for pelvic ring injuries in children, adolescents and young women, provided they are hemodynamically stable. Angiography, ultrasonography and bone scintigraphy are additional important diagnostic and therapeutic options. PRACTICAL RECOMMENDATIONS Knowledge of basic pelvic trauma mechanisms is important to understand the potential severity of traumatic pelvic fractures and to classify them correctly in terms of stability. Being familiar with typical concomitant injuries in pelvic ring fractures allows reliable diagnosis and their communication with the clinician. CT remains the "diagnostic workhorse". In fragile pelvic fractures, the often prolonged course with fracture progression must be taken into account, which is why MRI is of particular importance herein.
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Affiliation(s)
- Thomas Grieser
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
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Mostafa AMHAM, Kyriacou H, Chimutengwende-Gordon M, Khan WS. An overview of the key principles and guidelines in the management of pelvic fractures. J Perioper Pract 2020; 31:341-348. [PMID: 32894996 PMCID: PMC8406373 DOI: 10.1177/1750458920947358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pelvic fractures are complex injuries with a range of different presentations depending on the mechanism of trauma. Due to the morbidity and mortality of pelvic fractures, patients require thorough investigation and timely management with multidisciplinary input. Various surgical and non-surgical techniques can be used to treat pelvic fractures, as well as any associated visceral injuries. Following repair, it is important to remain vigilant for postoperative complications such as infection, sexual and urinary dysfunction, chronic pain and adverse psychological health. This article summarises the relevant UK guidance and literature and presents them in a format that follows the patient’s journey. In doing so, it highlights the key perioperative factors that need to be considered in cases of pelvic fracture.
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Affiliation(s)
| | - Harry Kyriacou
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Wasim S Khan
- Department of Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
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Watkins RJ, Hsu JM. The Road to Survival for Haemodynamically Unstable Patients With Open Pelvic Fractures. Front Surg 2020; 7:58. [PMID: 32984402 PMCID: PMC7493634 DOI: 10.3389/fsurg.2020.00058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 11/13/2022] Open
Abstract
Management of haemodynamically unstable pelvic ring injuries has been simplified into treatment algorithms to streamline care and emergent decision making in order to improve patient outcomes whilst decreasing mortality and morbidity. Pelvic ring injuries are most commonly a result of high-velocity and energy forces that exert trauma to the pelvic bones causing not only damage to the bone but the surrounding soft-tissue, organs, and other structures and are usually accompanied by injuries to other parts of the body resulting in a polytraumatised patient. Open pelvic fractures are a rare subset of pelvic ring fractures that are on the more severe end of the pelvic fracture continuum and usually produce uncontrolled haemorrhage from fractured bone, retroperitoneal haematomas, intraabdominal bleeding from bowel injury, soft tissue injuries to the anus, perineum, and genitals, fractures of the pelvic bones, causing bleeding from cancellous bone, venous, and arterial injuries combined with bleeding from concomitant injuries. This is a very complex and challenging clinical situation and timely and appropriate decisions and action are paramount for a positive outcome. Consequently, open pelvic fractures have an extremely high rate of mortality and morbidity and outcomes remain poor, despite evidence-based improvements in treatment, knowledge, and identification of haemorrhage; in the pre-hospital, critical care, and operative settings. In the future utilisation of haemostatic drugs, dressings, devices, and procedures may aid in the time to haemorrhage control.
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Affiliation(s)
| | - Jeremy M Hsu
- Trauma Service, Westmead Hospital, Westmead, NSW, Australia.,Discipline of Surgery, University of Sydney, Sydney, NSW, Australia
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42
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Abstract
IntroductionThe purpose of this study was to evaluate the utilization of pelvic binders, the proper placement of binders, and to determine any differences in blood product transfusions between combat casualties with and without a pelvic binder identified on initial imaging immediately after the injury.MethodsWe conducted a retrospective review of all combat-injured patients who arrived at our military treatment hospital between 2010 and 2012 with a documented pelvic fracture. Initial imaging (X-ray or computed tomography) immediately after injury were evaluated by 2 independent radiologists. Young-Burgess (YB) classification, pelvic diastasis, correct binder placement over the greater trochanters, and the presence of a pelvic external fixator (ex-fix) was recorded. Injury severity score (ISS), whole blood, and blood component therapy administered within the first 24-hours after injury were compared between casualties with and without a pelvic binder.Results39 casualties had overseas imaging to confirm and radiographically classify a YB pelvic ring injury. The most common fracture patterns were anteroposterior (53%) and lateral compression (28%). 49% (19/39) did not have a binder or ex-fix identified on initial imaging or in any documentation after injury. Ten patients had a binder, with 30% positioned incorrectly over the iliac crest. ISS (34 ± 1.6) was not statistically different between the binder and the no-binder group. Pubic symphysis diastasis was significantly lower in the binder group (1.4 ± 0.2 vs 3.7 ± 0.5, P < .001). There was a trend toward decreased 24-hour total blood products between the binder and no-binder groups (75 ± 11 vs 82 ± 13, P = .67). This was due to less cryoprecipitate in the binder group (6 ± 2 vs 19 ± 5, P = .01).ConclusionsPelvic binder placement in combat trauma may be inconsistent and an important area for continued training. While 24-hour total transfusions do not appear to be different, no-binder patients received significantly more cryoprecipitate.
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Abdelrahman H, El-Menyar A, Keil H, Alhammoud A, Ghouri SI, Babikir E, Asim M, Muenzberg M, Al-Thani H. Patterns, management, and outcomes of traumatic pelvic fracture: insights from a multicenter study. J Orthop Surg Res 2020; 15:249. [PMID: 32646448 PMCID: PMC7344030 DOI: 10.1186/s13018-020-01772-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 06/30/2020] [Indexed: 01/07/2023] Open
Abstract
Background Traumatic pelvic fracture (TPF) is a significant injury that results from high energy impact and has a high morbidity and mortality. Purpose We aimed to describe the epidemiology, incidence, patterns, management, and outcomes of TPF in multinational level 1 trauma centers. Methods We conducted a retrospective analysis of all patients with TPF between 2010 and 2016 at two trauma centers in Qatar and Germany. Results A total of 2112 patients presented with traumatic pelvic injuries, of which 1814 (85.9%) sustained TPF, males dominated (76.5%) with a mean age of 41 ± 21 years. In unstable pelvic fracture, the frequent mechanism of injury was motor vehicle crash (41%) followed by falls (35%) and pedestrian hit by vehicle (24%). Apart from both extremities, the chest (37.3%) was the most commonly associated injured region. The mean injury severity score (ISS) of 16.5 ± 13.3. Hemodynamic instability was observed in 44%. Blood transfusion was needed in one third while massive transfusion and intensive care admission were required in a tenth and a quarter of cases, respectively. Tile classification was possible in 1228 patients (type A in 60%, B in 30%, and C in 10%). Patients with type C fractures had higher rates of associated injuries, higher ISS, greater pelvis abbreviated injury score (AIS), massive transfusion protocol activation, prolonged hospital stay, complications, and mortality (p value < 0.001). Two-thirds of patients were managed conservatively while a third needed surgical fixation. The median length of hospital and intensive care stays were 15 and 5 days, respectively. The overall mortality rate was 4.7% (86 patients). Conclusion TPF is a common injury among polytrauma patients. It needs a careful, systematic management approach to address the associated complexities and the polytrauma nature.
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Affiliation(s)
- Husham Abdelrahman
- Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar. .,Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar.
| | - Holger Keil
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen am Rhein, Germany
| | | | - Syed Imran Ghouri
- Orthopedic Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Elhadi Babikir
- Orthopedic Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma & Vascular Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Matthias Muenzberg
- Department for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwig-Guttmann-Strasse 13, 67071, Ludwigshafen am Rhein, Germany
| | - Hassan Al-Thani
- Trauma & Vascular Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar
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Brouwers L, de Jongh MAC, de Munter L, Edwards M, Lansink KWW. Prognostic factors and quality of life after pelvic fractures. The Brabant Injury Outcome Surveillance (BIOS) study. PLoS One 2020; 15:e0233690. [PMID: 32525901 PMCID: PMC7289384 DOI: 10.1371/journal.pone.0233690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/10/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Pelvic fractures can have long-term consequences for health-related quality of life (HRQoL). The main purpose of this study is to provide insight into short-term HRQoL in the first year after pelvic injury and to identify short-term prognostic factors of decreased outcome. Methods This is a prospective, observational, multicenter, follow-up cohort study in which HRQoL and functional outcomes were assessed during 12-month follow-up of injured adult patients admitted to 1 of 10 hospitals in the county of Noord-Brabant, the Netherlands. The data were collected by self-reported questionnaires at 1 week (including preinjury assessment) and 1, 3, 6 and 12 months after injury. The EuroQoL-5D (EQ-5D), visual analog scale (VAS), Merle d’Aubigné Hip Score (MAHS) and Majeed Pelvic Score (MPS) were used. Multivariable mixed models were used to examine the course of the HRQoL and the prognostic factors for decreased HRQoL and functional outcomes over time. Results A total of 184 patients with pelvic fractures were identified between September 2015–September 2016; the fractures included 71 Tile A, 44 Tile B and 10 Tile C fractures and 59 acetabular fractures. At the pre-injury, 1 week, and 1, 3, 6 and 12 months after injury time points, the mean EQ-5D Index values were 0.90, 0.26, 0.45, 0.66, 0.77 and 0.80, respectively, and the mean EQ-VAS values were 83, 45, 57, 69, 75 and 75, respectively. At 6 and 12 months after injury, 22 and 25% of the MPS < 65 year group, 38 and 47% of the MPS ≥ 65 year group and 34 and 51% of the MAHS group, respectively, reached the maximum score. Pre-injury score, female gender and high Injury Severity Score (ISS) were important prognostic factors for a decreased HRQoL, and the EQ-5D VAS β = 0.43 (95% CI: 0.31 − 0.57), -6.66 (95% CI: -10.90 − -0.43) and -7.09 (95% CI: -6.11 − -5.67), respectively. Discussion Patients with pelvic fractures experience a reduction in their HRQoL. Most patients do not achieve the HRQoL of their pre-injury state within 1 year after trauma. Prognostic factors for decreased HRQoL are a low pre-injury score, high ISS and female gender. We do not recommend using the MAHS and MPS in mid- or long-term follow-up of pelvic fractures because of ceiling effects. Trial registration number NCT02508675.
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Affiliation(s)
- L. Brouwers
- Network Emergency Care Brabant, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
- * E-mail:
| | - M. A. C. de Jongh
- Network Emergency Care Brabant, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
- Department Trauma Topcare, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
| | - L. de Munter
- Department Trauma Topcare, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
| | - M. Edwards
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
| | - K. W. W. Lansink
- Department Trauma Topcare, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
- Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, Noord-Brabant, The Netherlands
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Marini CP, Sánchez-Molero Pérez SM, Betancourt-Ramírez A, McNelis J, Petrone P. An analysis of 979 patients with pelvic fractures stratified by the presence or absence of solid organ injury. Injury 2020; 51:1326-1330. [PMID: 32305162 DOI: 10.1016/j.injury.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pelvic fractures (PF) require high force mechanism and their severity have been linked with an increase in the incidence of associated injuries within the abdomen and chest. Our goal is to assess the impact of solid organ injury (SOI) on the outcome of patients with PF and to identify risk factors predictive of morbidity and mortality among these patients. STUDY DESIGN We conducted a single-center retrospective review of medical records of patients 16 years or older admitted to our level 1 trauma center with pelvic fracture with and without OI associated from blunt trauma between 1/1/2010-7/31/2015. RESULTS 979 patients with PF were identified. 261/979 (26.7%) had at least one associated SOI. The grade of the SOI ranged from I to III in 246 patients, grade IV in five patients and grade V in 10 patients with SOI sustained a higher pelvic AIS grade and required a statistically significant greater amount of blood products (BP). Thoracic and urogenital injuries were also more common. The mortality of patients with PF was not affected by the presence of SOI. Increasing age, Injury Severity Score, Glasgow Coma Scale, hypothermia and the amount of BP transfused were predictive of mortality. CONCLUSIONS The presence of SOI did not affect the outcome of patients with pelvic fracture, although our results may be linked to the limited number of patients with high grade SOI. The degree of pelvic AIS is predictive of associated injuries within the abdomen and chest.
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Affiliation(s)
- Corrado P Marini
- Department of Surgery, New York Medical College, Valhalla, NY, United States; Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | | | - Alejandro Betancourt-Ramírez
- Department of Surgery, Southside Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra University, Bay Shore, NY, United States
| | - John McNelis
- Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Patrizio Petrone
- Department of Surgery, NYU Langone Health-NYU Winthrop Hospital, NYU Long Island School of Medicine, 222 Station Plaza North, Suite 300, Mineola, NY 11501, United States.
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Impact of a simplified management algorithm on outcome following exsanguinating pelvic fractures: A 10-year experience. J Trauma Acute Care Surg 2020; 86:658-663. [PMID: 30531209 DOI: 10.1097/ta.0000000000002162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Optimal management of exsanguinating pelvic fractures remains controversial. Our previous experience suggested that management decisions based on a defined algorithm were associated with a significant reduction in transfusion requirements and mortality. Based on these outcomes, a clinical pathway (PW) for the management of exsanguinating pelvic fractures was developed. The purpose of this study was to evaluate the impact of this PW on outcomes. METHODS Consecutive patients over 10 years with blunt pelvic fractures subsequent to the implementation of the clinical PW were identified. Patients with hemodynamically unstable pelvic fractures are managed initially with a pelvic orthotic device. For those with continued hemodynamic instability and no extrapelvic source of hemorrhage, pelvic angiography was performed followed by elective pelvic fixation. Patients managed according to the PW were compared with those patients whose management deviated (DEV) from the PW. RESULTS There were 3,467 patients identified. Three hundred twelve (9%) met entry criteria: 246 (79%) comprised the PW group and 66 (21%) the DEV group. Injury severity, as measured by Injury Severity Score (35 vs. 36; p = 0.55), admission Glasgow Coma Scale (10 vs. 10; p = 0.58), admission BE (-7.4 vs. -6.4, p = 0.38), admission SBP (107 vs. 104, p = 0.53), and PRBC requirements during initial resuscitation (6.1 units vs. 6.6 units, p = 0.22) were similar between the groups. Pelvic orthotic device use was 48% in the DEV group (p < 0.001). Twenty-four percent of the PW group required angiography compared with 74% of the DEV group (p < 0.001). Forty-eight-hour transfusions (11 vs. 16, p = 0.01) and mortality (35% vs. 48%, p = 0.04) were reduced in the PW group compared with the DEV group. Pathway adherence was identified as an independent predictor of both decreased transfusions (β = -5.8, p = 0.002) via multiple linear regression and decreased mortality (hazard ratio, 0.74; 95% confidence interval, 0.42-0.98) via multivariable cox proportional hazards analysis. CONCLUSION Adherence to a defined clinical PW simplified the management of exsanguinating pelvic fractures and contributed to a reduction in both transfusion requirements and mortality. LEVEL OF EVIDENCE Prognostic, level III.
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47
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Zingg T, Piaget-Rossel R, Steppacher J, Carron PN, Dami F, Borens O, Albrecht R, Darioli V, Taffé P, Maudet L, Pasquier M. Prehospital use of pelvic circumferential compression devices in a physician-based emergency medical service: A 6-year retrospective cohort study. Sci Rep 2020; 10:5106. [PMID: 32198451 PMCID: PMC7083961 DOI: 10.1038/s41598-020-62027-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/06/2020] [Indexed: 11/20/2022] Open
Abstract
Fractures of the pelvic ring are a potential source of significant bleeding. Pelvic circumferential compression devices (PCCDs) can reduce and immobilize unstable fractures, but their hemostatic effect is unproven. Our aim was to assess the current practice of prehospital PCCD application and to identify factors available in the field predictive of significant pelvic ring injuries. All interventions (n = 13,435) in the Lausanne University Hospital Emergency Medical Service (EMS) were screened for PCCD placements from January 2008 to November 2014. Significant pelvic ring injuries (Tile types B or C) were considered as potentially benefitting from a PCCD. Data were extracted from the local prehospital registry. During the study period, 2366 trauma missions were performed. A PCCD was applied to 552/2366 (23%) patients. Significant pelvic ring injuries were present in 105/2366 (4.4%). Factors associated with the presence of significant pelvic ring injury were increased respiratory rate (OR 1.04), prolonged capillary refill time (OR 2.11), increased shock index (OR 3.91), pedestrians hit by a vehicle (OR 2.19), and presenting with falls from more than 2 m (OR 1.91). Among patients with a significant pelvic ring injury, a PCCD was placed in 79 (75%) and omitted in 26 (25%). One sixth of patients with a PCCD had a final diagnosis of significant pelvic ring injury. Further studies are needed to better understand which patient-, or accident-related factors are associated with prehospital PCCD omission among patients with significant pelvic ring injury.
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Affiliation(s)
- Tobias Zingg
- Department of Visceral Surgery, Lausanne University Hospital - CHUV, Lausanne, Switzerland.
| | - Romain Piaget-Rossel
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Julie Steppacher
- School of Medicine and Biology, University of Lausanne, Lausanne, Switzerland
| | - Pierre-Nicolas Carron
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Fabrice Dami
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopedics and Traumatology, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | | | - Vincent Darioli
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Patrick Taffé
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Ludovic Maudet
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
| | - Mathieu Pasquier
- Department of Emergency Medicine, Lausanne University Hospital - CHUV, Lausanne, Switzerland
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McCreary D, Cheng C, Lin ZC, Nehme Z, Fitzgerald M, Mitra B. Haemodynamics as a determinant of need for pre-hospital application of a pelvic circumferential compression device in adult trauma patients. Injury 2020; 51:4-9. [PMID: 31431329 DOI: 10.1016/j.injury.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/23/2019] [Accepted: 08/03/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pelvic ring fractures are common following high-energy blunt trauma and can lead to substantial haemorrhage, morbidity and mortality. Pelvic circumferential compression devices (PCCDs) improve position and stability of open-book type pelvic fracture, and can improve haemodynamics in patients with hypovolaemic shock. However, PCCDs may cause adverse outcomes including worsening of lateral compression fracture patterns and routine use is associated with high costs. Controversy regarding indication of PCCDs exists with some centres recommending PCCD in the setting of hypovolaemic shock compared to placement for any suspected pelvic injury. OBJECTIVE To assess the need for PCCD application based on pre-hospital vital signs and mechanism of injury. METHODS A retrospective cohort study was conducted in a single adult major trauma centre examining a 2-year period. Patients were sub-grouped based on initial pre-hospital and emergency department observations as haemodynamically normal (heart rate <100 bpm, systolic blood pressure ≥100 mmHg and Glasgow Coma Scale ≥13) or abnormal. Diagnostic accuracy of pre-hospital haemodynamics as a predictor of pelvic fracture requiring intervention within 24 h was assessed. RESULTS There were 376 patients with PCCD in-situ on hospital arrival. Pelvic fractures were diagnosed in 137 patients (36.4%). Of these, 39 (28.5%) were haemodynamically normal and 98 (71.5%) were haemodynamically abnormal. The most common mechanisms of injury were motor vehicle collision (57.7%) and motorcycle collision (13.8%). Of those with fractures, 40 patients (29.2%) required pelvic intervention within 24 h of admission; of these, 8 (20%) were haemodynamically normal and 32 (80%) were haemodynamically abnormal. As a test for pelvic fracture requiring intervention within 24 h, abnormal pre-hospital haemodynamics had a sensitivity of 0.80 (95% CI 0.64-0.91), specificity of 0.32 (95% CI 0.27-0.38) and negative predictive value (NPV) of 0.93 (95% CI 0.88-0.96). Combined with absence of a major mechanism of injury, normal haemodynamics had a sensitivity 1.00, specificity 0.51 (95% CI 0.36-0.66) and NPV of 1.00 for pelvic intervention within 24 h. CONCLUSION Normal haemodynamic status, combined with absence of major mechanism of injury can rule out requirement for urgent pelvic intervention. Ongoing surveillance is recommended to monitor for any adverse effects of this change in practice.
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Affiliation(s)
- D McCreary
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia.
| | - C Cheng
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia
| | - Z C Lin
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia
| | - Z Nehme
- Department of Research & Evaluation, Ambulance Victoria, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Australia; Department of Community Emergency Health & Paramedic Practice, Monash University, Australia
| | - M Fitzgerald
- Trauma Services, Alfred Health, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - B Mitra
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
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Chen HT, Wang YC, Hsieh CC, Su LT, Wu SC, Lo YS, Chang CC, Tsai CH. Trends and predictors of mortality in unstable pelvic ring fracture: a 10-year experience with a multidisciplinary institutional protocol. World J Emerg Surg 2019; 14:61. [PMID: 31889991 PMCID: PMC6935111 DOI: 10.1186/s13017-019-0282-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/16/2019] [Indexed: 12/13/2022] Open
Abstract
Background Pelvic ring fracture is often combined with other injuries and such patients are considered at high risk of mortality and complications. There is controversy regarding the gold standard protocol for the initial treatment of pelvic fracture. The aim of this study was to assess which risk factors could affect the outcome and to analyze survival using our multidisciplinary institutional protocol for traumatic pelvic ring fracture. Material and methods This retrospective study reviewed patients who sustained an unstable pelvic ring fracture with Injury Severity Score (ISS) ≥ 5. All patients were admitted to the emergency department and registered in the Trauma Registry System of a level I trauma center from January 1, 2008, to December 31, 2017. The annular mortality rate after the application of our institutional protocol was analyzed. Patients with different systems of injury and treatments were compared, and regression analysis was performed to adjust for factors that could affect the rate of mortality and complications. Results During the 10-year study period, there were 825 unstable pelvic ring injuries, with a mean ISS higher than that of other non-pelvic trauma cases. The annual mortality rate declined from 7.8 to 2.4% and the mean length of stay was 18.1 days. A multivariable analysis showed that unstable initial vital signs, such as systolic blood pressure < 90 mmHg (odds ratio [OR] 2.53; confidence interval [CI] 1.11–5.73), Glasgow Coma Scale < 9 (OR 3.87; CI 1.57–9.58), 24 > ISS > 15 (OR 4.84; CI 0.85–27.65), pulse rate < 50 (OR 11.54; CI 1.21–109.6), and diabetes mellitus (OR 3.18; CI 1.10–9.21) were associated with higher mortality. No other specific system in the high Abbreviated Injury Scale increased the rates of mortality or complications. Conclusion Poor initial vital signs and Glasgow Coma Scale score, higher ISS score, and comorbidity of diabetes mellitus affect the mortality rate of patients with unstable pelvic ring fractures. No single system of injury was found to increase mortality in these patients. The mortality rate was reduced through institutional efforts toward the application of guidelines for the initial management of pelvic fracture.
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Affiliation(s)
- Hsien-Te Chen
- 1Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan.,2Spine Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.,3Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan
| | - Yu-Chun Wang
- 4Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,5Department of Surgery, School of Medicine, China Medical University, Taichung, Taiwan.,6Division of Emergency Disease Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Chen-Chou Hsieh
- 4Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Li-Ting Su
- 4Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,6Division of Emergency Disease Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Chi Wu
- 4Department of Surgery, China Medical University Hospital, Taichung, Taiwan.,5Department of Surgery, School of Medicine, China Medical University, Taichung, Taiwan.,6Division of Emergency Disease Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yuan-Shun Lo
- 1Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan.,2Spine Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.,3Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan
| | - Chien-Chun Chang
- 1Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan.,2Spine Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.,3Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan
| | - Chun-Hao Tsai
- 1Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan.,2Spine Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.,3Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan.,7Department of Orthopedic Surgery, School of Medicine, China Medical University, #91 Hsueh-Shih Road, Taichung, 404 Taiwan
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50
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Hammer M, Gutbrod A, Sigrist NE, Jacot V, Del Chicca F, Evans R, Pozzi A. Predictors of comorbidities and mortality in cats with pelvic fractures. Vet Surg 2019; 49:281-290. [PMID: 31876001 DOI: 10.1111/vsu.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/14/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To characterize and evaluate risk factors for comorbidities and death of cats with pelvic fractures. STUDY DESIGN Retrospective case study. ANIMALS Cats (n = 280). METHODS Medical records were reviewed for cats in which pelvic fractures had been diagnosed (January 2003 to November 2016). Retrieved data included signalment, mechanism of injury, clinical findings, diagnostic imaging investigations, type and number of concurrent injuries based on anatomical location, type of therapy, and survival. Pelvic fractures were classified according to location and severity. Descriptive statistics were performed, and logistic regression models were constructed to examine associations between risk factors and outcome. RESULTS Cases consisted of 280 cats with no (9%), unilateral (43%), and bilateral (48%) involvement of the weight-bearing axis. Sacral fractures were found in 12% of cats. Surgical treatment and mortality rates increased progressively with the severity of the pelvic fractures (P < .001). Mean number of concurrent body regions injured was 2.4 ± 1.2 and was associated with mortality (P < .01). Twenty percent of cats did not survive to discharge. Cats with neurologic injuries were more likely not to survive (P = .02). CONCLUSION Concurrent injuries to at least one body region, especially the abdomen and thorax, were observed in cats sustaining pelvic fractures. Mortality was associated with increased severity of the fractures, neurologic injuries, and increased number of concurrent injuries. CLINICAL SIGNIFICANCE Concurrent injuries are common in cats with pelvic fractures, and comorbidities may be associated with mortality.
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Affiliation(s)
- Meike Hammer
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Nadja E Sigrist
- Division of Critical Care Medicine, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Francesca Del Chicca
- Clinic for Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Antonio Pozzi
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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