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Short-Term Functional Outcomes and Quality of Life after B2.1 Type Pelvic Fractures for Surgically and Non-Surgically Treated Young Patients. ACTA ACUST UNITED AC 2021; 57:medicina57060513. [PMID: 34063870 PMCID: PMC8224058 DOI: 10.3390/medicina57060513] [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: 05/13/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
Background and Objectives: Lateral compression injuries of the pelvic ring are most common among young and elderly patients. Of all pelvic ring fracture injuries, the B2.1 type—involving lateral compression of the pelvic ring—is the most common. Despite this, we still have no high-level evidence to consult when choosing between the surgical and non-operative approaches. The purpose of this research was to compare the short-term functional and quality of life outcomes between operatively and non-operatively treated young patients after a B2.1 type pelvic fracture. Materials and Methods: Patients aged 18 to 65 years with pelvic B2.1 type fractures—according to AO/Tile classification—that were hospitalized in a single trauma center between 2016 November and 2019 September were included in the research. Patients were retrospectively divided into two groups regarding their treatment: non-operative and operative. Functional outcomes were evaluated using Majeed score, and SF-36 was used for the evaluation of quality of life. Patients completed these questionnaires twice: first during hospitalization, regarding their pre-traumatic condition (timepoint I); and again 10 weeks after the injury, regarding their current condition (timepoint II). Results: A total of 55 patients (70.6% of whom were female) with type B2.1 pelvic fractures were included in the analysis, with an average age of 37.24 ± 13.78 years. There were 21 (38.18%) patients with high injury severity, and 37 (67.3%) patients were treated operatively versus 18 (32.7%) non-operatively. Between the two timepoints, Majeed score reduced by 34.08 ± 18.95 for operatively and 31.44 ± 14.41 for non-operatively treated patients. For operatively and non-operatively treated patients, the physical component summary (PCS) of the SF-36 questionnaire reduced by 19.45 ± 9.95 and 19.36 ± 7.88, respectively, while the mental component summary (MCS) reduced by 6.38 ± 11.04 and 7.23 ± 10.86, respectively. Conclusions: We observed that operative treatment of B2.1 type pelvic fractures for young patients is not superior to non-operative in the short-term, because the functional outcomes and quality of life are similar in both groups.
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Kuršumović K, Hadeed M, Bassett J, Parry JA, Bates P, Acharya MR. Lateral compression type 1 (LC1) pelvic ring injuries: a spectrum of fracture types and treatment algorithms. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:841-854. [PMID: 33860399 DOI: 10.1007/s00590-021-02935-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
Lateral compression type 1 (LC1) fractures are the commonest pelvic ring injury. However, they represent a heterogenous spectrum of injury mechanisms and fracture patterns, resulting in a lack of strong evidence for a universally agreed treatment algorithm. Although consensus exists that LC1 fractures have a preserved posterior ligamentous complex and are vertically stable, controversy persists around defining internal rotational instability. As such, treatment strategies extend from routine non-operative management through to dynamic imaging such as examination under anaesthetic (EUA) or stress radiographs to guide fixation algorithm. Multiple protocols sit between these two, all with slightly different thresholds for advocating surgery or otherwise, exemplifying a broad lack of consensus that is not seen for other, more severe, grades of pelvic ring injury. In the following review we discuss the evolving concepts of pelvic ring instability and management, starting from a historical perspective, through to current trends and controversies in LC1 fracture treatment. Emerging directions for research and emerging pharmacological and surgical treatments/technologies are also considered and expert commentary from 3 leading centres provided. The distinction is made between LC1 fracture arising from high-energy trauma and those following low-energy falls from standing height (so-called fragility fractures of the pelvis-FFP), since these two patient groups have different functional requirements and medical vulnerabilities. Issues pertaining to FFP are considered separately.
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Affiliation(s)
- Kenan Kuršumović
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Michael Hadeed
- Department of Orthopaedic Surgery, Denver Health Medical Centre, University of Colorado School of Medicine, Denver, CO, USA
| | - James Bassett
- Department of Trauma and Orthopaedics, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Joshua A Parry
- Department of Orthopaedic Surgery, Denver Health Medical Centre, University of Colorado School of Medicine, Denver, CO, USA
| | - Peter Bates
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, The Royal London Hospital, London, UK.
| | - Mehool R Acharya
- Department of Trauma and Orthopaedics, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
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Kim MJ, Lee JG, Kim EH, Lee SH. A nomogram to predict arterial bleeding in patients with pelvic fractures after blunt trauma: a retrospective cohort study. J Orthop Surg Res 2021; 16:122. [PMID: 33557886 PMCID: PMC7869209 DOI: 10.1186/s13018-021-02247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/18/2021] [Indexed: 12/04/2022] Open
Abstract
Background Pelvic bone fractures are one of the biggest challenges faced by trauma surgeons. Especially, the presence of bleeding and hemodynamic instability features is associated with high morbidity and mortality in patients with pelvic fractures. However, prediction of the occurrence of arterial bleeding causing massive hemorrhage in patients with pelvic fractures is difficult. Therefore, the aim of this study was to develop a nomogram to predict arterial bleeding in patients with pelvic bone fractures after blunt trauma. Methods The medical records of 1404 trauma patients treated between January 2013 and August 2017 were retrospectively reviewed. Patients older than 15 years with a pelvic fracture due to blunt trauma were enrolled (n = 148). The pelvic fracture pattern on anteroposterior radiography was classified according to the Orthopedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen (OTA/AO) system. Multivariable logistic regression modeling was used to determine the independent risk factors for arterial bleeding. A nomogram was constructed based on the identified risk factors. Results The most common pelvic fracture pattern was type A (58.8%), followed by types B (34.5%) and C (6.7%). Of the 148 patients, 28 (18.9%) showed pelvic arterial bleeding on contrast-enhanced computed tomography or angiography, or in the operative findings. The independent risk factors for arterial bleeding were a type B or C pelvic fracture pattern, body temperature < 36 °C, and serum lactate level > 3.4 mmol/L. A nomogram was developed using these three parameters, along with a systolic blood pressure < 90 mmHg. The area under the receiver operating characteristic curve of the predictive model for discrimination was 0.8579. The maximal Youden index was 0.1527, corresponding to a cutoff value of 68.65 points, which was considered the optimal cutoff value for predicting the occurrence of arterial bleeding in patients with pelvic bone fractures. Conclusions The developed nomogram, which was based on the initial clinical findings identifying risk factors for arterial bleeding, is expected to be helpful in rapidly establishing a treatment plan and improving the prognosis for patients with pelvic bone fractures. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02247-2.
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Affiliation(s)
- Myoung Jun Kim
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Jae Gil Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Hwa Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hwan Lee
- Department of Trauma Surgery, Gachon University Gil Medical Center, 21, Namdong-daero 774beon-gil, Namdong-gu, Incheon, Republic of Korea.
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Gwak J, Yoon YC, Lee MA, Yu B, Jang MJ, Choi KK. Blush on Computed Tomography and Transcatheter Arterial Embolization in Pelvic Fracture. JOURNAL OF TRAUMA AND INJURY 2016. [DOI: 10.20408/jti.2016.29.4.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jihun Gwak
- Department of Trauma Surgery, Gachon University, Gil Medical Center, Incheon, Korea
| | - Yong-Cheol Yoon
- Department of Trauma Surgery, Gachon University, Gil Medical Center, Incheon, Korea
| | - Min A Lee
- Department of Trauma Surgery, Gachon University, Gil Medical Center, Incheon, Korea
| | - Byungchul Yu
- Department of Trauma Surgery, Gachon University, Gil Medical Center, Incheon, Korea
| | - Myung Jin Jang
- Department of Trauma Surgery, Gachon University, Gil Medical Center, Incheon, Korea
| | - Kang Kook Choi
- Department of Trauma Surgery, Gachon University, Gil Medical Center, Incheon, Korea
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Höch A, Schneider I, Todd J, Josten C, Böhme J. Lateral compression type B 2-1 pelvic ring fractures in young patients do not require surgery. Eur J Trauma Emerg Surg 2016; 44:171-177. [PMID: 27138008 DOI: 10.1007/s00068-016-0676-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/21/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE According to Young and Burgess, type B 2-1 pelvic fractures are a type of lateral compression fracture (LC-1) and are the most common pelvic injury at all ages. Although they are considered unstable in rotation and despite biomechanical recommendations for anterior stabilization, most authors recommend non-operative treatment. However, studies comparing outcomes and complications regarding operative versus non-operative treatment are still scarce. METHODS Seventy-one patients aged under 65 years with a type B 2-1 pelvic fracture were treated between 2006 and 2011. Patients in Group I (n = 35) were treated non-operatively and patients in Group II (n = 36) were treated operatively. Postoperative complications, clinical course, and follow-up (VAS for Pain, SF 36, EQ-5D) of at least 1 year postoperatively were evaluated. RESULTS Our data show that operatively treated patients had a significantly higher complication rate. Preoperatively, the only significant difference between the non-operative and operative groups was the amount of anterior fracture dislocation and the presence of an isolated pelvic ring fracture. In the postoperative follow-up, no significant differences were found regarding pain or quality of life. CONCLUSION Type B 2-1 pelvic ring fractures in young patients should be treated non-operatively.
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Affiliation(s)
- A Höch
- Department of Orthopaedics, Trauma and Plastic Surgery, Center for Musculoskeletal Research, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - I Schneider
- Department of Orthopaedics, Trauma and Plastic Surgery, Center for Musculoskeletal Research, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - J Todd
- Department of Orthopaedics, Trauma and Plastic Surgery, Center for Musculoskeletal Research, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - C Josten
- Department of Orthopaedics, Trauma and Plastic Surgery, Center for Musculoskeletal Research, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - J Böhme
- Department of Orthopaedics, Trauma and Plastic Surgery, Center for Musculoskeletal Research, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Hoffberg JE, Koenigshof AM, Guiot LP. Retrospective evaluation of concurrent intra-abdominal injuries in dogs with traumatic pelvic fractures: 83 cases (2008-2013). J Vet Emerg Crit Care (San Antonio) 2016; 26:288-94. [DOI: 10.1111/vec.12430] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 06/21/2014] [Accepted: 06/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Jamie E. Hoffberg
- Department of Clinical Sciences, College of Veterinary Medicine; Michigan State University; East Lansing MI 48824
| | - Amy M. Koenigshof
- Department of Clinical Sciences, College of Veterinary Medicine; Michigan State University; East Lansing MI 48824
| | - Laurent P. Guiot
- Department of Veterinary Clinical Sciences, Veterinary Medical Center at Dublin; The Ohio State University; Dublin OH 43017
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Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment. Injury 2013; 44:1733-44. [PMID: 23871193 DOI: 10.1016/j.injury.2013.06.023] [Citation(s) in RCA: 274] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 06/20/2013] [Indexed: 02/02/2023]
Abstract
Due to the increasing life expectancy, orthopaedic surgeons are more and more often confronted with fragility fractures of the pelvis (FFPs). These kinds of fractures are the result of a low-energy impact or they may even occur spontaneously in patients with severe osteoporosis. Due to some distinct differences, the established classifications for pelvic ring lesions in younger adults do not fully reflect the clinical and morphological criteria of FFPs. Most FFPs are minimally displaced and do not require surgical therapy. However, in some patients, an insidious progress of bone damage leads to increasing displacement, nonunion and persisting instability. Therefore, new concepts for surgical treatment have to be developed to address the functional needs of the elderly patients. Based on an analysis of 245 consecutive patients with FFPs, we propose a novel classification system for this condition. This classification is based on morphological criteria and it corresponds with the degree of instability. Also in the elderly, these criteria are the most important for the decision on the type of treatment as well as type and extent of surgery. The estimation of the degree of instability is based on radiological and clinical findings. The classification gives also hints for treatment strategies, which may vary between minimally invasive techniques and complex surgical reconstructions.
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Affiliation(s)
- Pol Maria Rommens
- Department of Trauma Surgery, Centre for Muskuloskeletal Surgery, University Medical Centre Mainz, Mainz, Germany.
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Dienstknecht T, Pfeifer R, Horst K, Sellei RM, Berner A, Zelle BA, Probst C, Pape HC. The long-term clinical outcome after pelvic ring injuries. Bone Joint J 2013; 95-B:548-53. [DOI: 10.1302/0301-620x.95b4.30804] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the functional and socioeconomic long-term outcome of patients with pelvic ring injuries. We identified 109 patients treated at a Level I trauma centre between 1973 and 1990 with multiple blunt orthopaedic injuries including an injury to the pelvic ring, with an Injury Severity Score (ISS) of ≥ 16. These patients were invited for clinical review at a minimum of ten years after the initial injury, at which point functional results, general health scores and socioeconomic factors were assessed. In all 33 isolated anterior (group A), 33 isolated posterior (group P) and 43 combined anterior/posterior pelvic ring injuries (group A/P) were included. The mean age of the patients at injury was 28.8 years (5 to 55) and the mean ISS was 22.7 (16 to 44). At review the mean Short-Form 12 physical component score for the A/P group was 38.71 (22.12 to 56.56) and the mean Hannover Score for Polytrauma Outcome subjective score was 67.27 (12.48 to 147.42), being significantly worse compared with the other two groups (p = 0.004 and p = 0.024, respectively). A total of 42 patients (39%) had a limp and 12 (11%) required crutches. Car or public transport usage was restricted in 16 patients (15%). Overall patients in groups P and A/P had a worse outcome. The long-term outcome of patients with posterior or combined anterior/posterior pelvic ring injuries is poorer than of those with an isolated anterior injury. Cite this article: Bone Joint J 2013;95-B:548–53.
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Affiliation(s)
- T. Dienstknecht
- University of Aachen Medical Center, Department
of Orthopaedic Trauma, 30 Pauwels street, 52074
Aachen, Germany
| | - R. Pfeifer
- University of Aachen Medical Center, Department
of Orthopaedic Trauma, 30 Pauwels street, 52074
Aachen, Germany
| | - K. Horst
- University of Aachen Medical Center, Department
of Orthopaedic Trauma, 30 Pauwels street, 52074
Aachen, Germany
| | - R. M. Sellei
- University of Aachen Medical Center, Department
of Orthopaedic Trauma, 30 Pauwels street, 52074
Aachen, Germany
| | - A. Berner
- University Hospital Regensburg, Department
of Trauma Surgery, Franz-Josef-Strauss-Allee
11, 93053 Regensburg, Germany
| | - B. A. Zelle
- UT Health Science Center at San Antonio, Department
of Orthopaedic Surgery, Division of Orthopaedic
Traumatology 7703 Floyd Curl Dr, MC-7774, San
Antonio, TX 78229, USA
| | - C. Probst
- Cologne Merheim Medical Center, Department
of Trauma and Orthopaedic Surgery, Ostmerheimer
Str. 200, 51109 Cologne, Germany
| | - H-C. Pape
- University of Aachen Medical Center, Department
of Orthopaedic Trauma, 30 Pauwels street, 52074
Aachen, Germany
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Tosounidis T, Kanakaris N, Nikolaou V, Tan B, Giannoudis PV. Assessment of Lateral Compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable? INTERNATIONAL ORTHOPAEDICS 2012; 36:2553-8. [PMID: 23096135 DOI: 10.1007/s00264-012-1685-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 10/11/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE We performed a prospective study to document, by intra-operative manipulation under anaesthesia (MUA) of the pelvic ring, the stability of lateral compression type 1 injuries that were managed in a Level-I Trauma Centre. The documentation of the short-term outcome of the management of these injuries was our secondary aim. METHODS A total of 63 patients were included in the study. Thirty-five patients (group A) were treated surgically whereas 28 (group B) were managed nonoperatively. Intraoperative rotational instability, evident by more than two centimetres of translation during the manipulation manoeuvre, was combined with a complete sacral fracture in all cases. RESULTS A statistically significant difference was present between the length of hospital stay, the time to independent pain-free mobilisation, post-manipulation pain levels and opioid requirements between the two groups, with group A demonstrating significantly decreased values in all these four variables (p < 0.05). There was also a significant difference between the pre- and 72-hour post-manipulation visual analogue scale and analgesic requirements of the group A patients, whereas the patients in group B did not demonstrate such a difference. CONCLUSION LC-1 injuries with a complete posterior sacral injury are inheritably rotationally unstable and patients presenting with these fracture patterns definitely gain benefit from surgical stabilisation.
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Affiliation(s)
- Theodoros Tosounidis
- Academic Department of Trauma and Orthopaedics, School of Medicine, Leeds General Infirmary, University of Leeds, Clarendon Wing, Level A, Great George Street, LS1 3EX, Leeds, West Yorkshire, UK
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Abstract
Pelvic fractures were sustained by ≥26% of service members who died during Operation Enduring Freedom and Operation Iraqi Freedom in 2008. To determine factors associated with patient mortality following combat-related pelvic fracture (CRPF), the Joint Theater Trauma Registry database was searched to identify service members who survived CRPF sustained in the year 2008 (group 1), and the Armed Forces Medical Examiner System was searched to identify nonsurvivors of such trauma in the same year (group 2). Stable pelvic ring injuries were associated with a lower mortality rate than were unstable injuries when controlling for large-vessel and anatomic brain injuries (43% and 85%, respectively; P < 0.05). Associated injuries that were significant predictors of mortality included large-vessel, anatomic brain, cardiopulmonary, and solid organ abdominal (P < 0.05). Compared with a similar cohort of nonsurvivors, persons who survive CRPF have less severe pelvic fractures and associated injuries. In addition, pelvic fractures secondary to direct combat (ie, blast-related blunt injury, penetrating injury) were significantly more lethal than were those caused by mechanisms analogous to civilian trauma.
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