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Purpose Unstable pelvic ring injury can result in a life-threatening situation and lead to long-term disability. Established classification systems, recently emerged resuscitative and treatment options as well as techniques, have facilitated expansion in how these injuries can be studied and managed. This study aims to access practice variation in the management of unstable pelvic injuries around the globe. Methods A standardized questionnaire including 15 questions was developed by experts from the SICOT trauma committee (Société Internationale de Chirurgie Orthopédique et de Traumatologie) and then distributed among members. The survey was conducted online for one month in 2022 with 358 trauma surgeons, encompassing responses from 80 countries (experience > 5 years = 79%). Topics in the questionnaire included surgical and interventional treatment strategies, classification, staging/reconstruction procedures, and preoperative imaging. Answer options for treatment strategies were ranked on a 4-point rating scale with following options: (1) always (A), (2) often (O), (3) seldom (S), and (4) never (N). Stratification was performed according to geographic regions (continents). Results The Young and Burgess (52%) and Tile/AO (47%) classification systems were commonly used. Preoperative three-dimensional (3D) computed tomography (CT) scans were utilized by 93% of respondents. Rescue screws (RS), C-clamps (CC), angioembolization (AE), and pelvic packing (PP) were observed to be rarely implemented in practice (A + O: RS = 24%, CC = 25%, AE = 21%, PP = 25%). External fixation was the most common method temporized fixation (A + O = 71%). Percutaneous screw fixation was the most common definitive fixation technique (A + O = 57%). In contrast, 3D navigation techniques were rarely utilized (A + O = 15%). Most standards in treatment of unstable pelvic ring injuries are implemented equally across the globe. The greatest differences were observed in augmented techniques to bleeding control, such as angioembolization and REBOA, more commonly used in Europe (both), North America (both), and Oceania (only angioembolization). Conclusion The Young-Burgess and Tile/AO classifications are used approximately equally across the world. Initial non-invasive stabilization with binders and temporary external fixation are commonly utilized, while specific haemorrhage control techniques such as pelvic packing and angioembolization are rarely and REBOA almost never considered. The substantial regional differences’ impact on outcomes needs to be further explored.

Purpose Although the term “major fracture” is commonly used in the management of trauma patients, it is defined insufficiently to date. The polytrauma section of ESTES is trying to develop a more standardized use and a definition of the term. In this process, a standardized literature search was undertaken. We test the hypothesis that the understanding of “major fractures” has changed and is modified by a better understanding of patient physiology. Methods A systematic literature search of the Medline and EMBASE databases was conducted in March 2022. Original studies that investigated surgical treatment strategies in polytraumatized patients with fractures were included: This included timing, sequence and type of operative treatment. A qualitative synthesis regarding the prevalence of anatomic regions of interest and core factors determining decision-making was performed. Data were stratified by decades. Results 4278 articles were identified. Of these, 74 were included for qualitative evaluation: 50 articles focused on one anatomic region, 24 investigated the relevance of multiple anatomic regions. Femur fractures were investigated most frequently (62) followed by pelvic (22), spinal (15) and tibial (15) fractures. Only femur (40), pelvic (5) and spinal (5) fractures were investigated in articles with one anatomic region of interest. Before 2010, most articles focused on long bone injuries. After 2010, fractures of pelvis and spine were cited more frequently. Additional determining factors for decision-making were covered in 67 studies. These included chest injuries (42), TBI (26), hemorrhagic shock (25) and other injury-specific factors (23). Articles before 2000 almost exclusively focused on chest injury and TBI, while shock and injury-specific factors (e.g., soft tissues, spinal cord injury, and abdominal trauma) became more relevant after 2000. Conclusion Over time, the way “major fractures” influenced surgical treatment strategies has changed notably. While femur fractures have long been the only focus, fixation of pelvic and spinal fractures have become more important over the last decade. In addition to the fracture location, associated conditions and injuries (chest trauma and head injuries) influence surgical decision-making as well. Hemodynamic stability and injury-specific factors (soft tissue injuries) have increased in importance over time.

Study design Single center, two-parallel group, blinding feasibility randomized controlled trial. Background Clinical trials of manual therapy interventions for back pain face methodological challenges regarding blinding of assigned interventions. We assessed blinding of participants and outcome assessors in a methodological randomized trial of two manual therapy interventions of the back and explored factors influencing perceptions about intervention assignment. Methods In a doctoral-level Introduction to Epidemiology course on 7–8 November 2022, 24 healthy students were randomly allocated (1:1) to active or control manual therapy interventions. The active manual therapy group (n = 11) received soft tissue mobilization of the lumbar musculature. The control group (n = 13) performed deep breathing exercises while receiving light touch over the thoracic region. The primary outcome was blinding feasibility of study participants immediately after intervention, derived from a 5-point scale and measured by the Bang blinding index (Bang BI), with values ranging from − 1 (opposite guessing) to 1 (complete unblinding), with 0 indicating random guessing (50% correct). Secondary outcomes included blinding feasibility of outcome assessors and factors influencing perceptions about intervention assignment in participants and outcome assessors, explored via thematic analysis. Results 24 participants were analyzed following an intention-to-treat approach. 55% of participants in the active manual therapy group correctly identified their group allocation beyond chance immediately after intervention (Bang BI: 0.55 [95% confidence interval (CI), 0.25 to 0.84]), and 8% did so in the control manual therapy group (0.08 [95% CI, -0.37 to 0.53]). Bang BIs in outcome assessors suggested adequate blinding, with indices of 0.09 (-0.12 to 0.30) and − 0.10 (-0.29 to 0.08) for perceived allocation of active and control manual therapy participants, respectively. Blinding estimates were limited due to imprecision and suboptimal generalizability to real-world clinical settings. Participants and outcome assessors reported varying factors related to perceived intervention arm allocation. Conclusions Our findings suggest that blinding of participants and outcome assessors immediately after a one-time manual therapy intervention is feasible in randomized controlled trial settings. Careful thinking and consideration of blinding in manual therapy intervention trials is warranted and needed. Trial registration: Retrospectively registered at ClinicalTrials.gov ― currently under Protocol Registration and Results System (PRS) review.