Evaluation of strategies for the treatment of type B and C pelvic fractures

Schmal, Hagen; Froberg, Lonnie; Larsen, Morten Schultz; Südkamp, Norbert P.; Pohlemann, Tim; Aghayev, Emin; Burri, Kelly Goodwin

doi:10.1302/0301-620x.100b7.bjj-2017-1377.r1

Cited by 22 publications

(13 citation statements)

References 21 publications

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“…The outcomes of interest included complications (any general, any infection), and death analyzed as binary variables and registered during the whole hospital stay from admission to discharge. As recently described [9], general complications included thrombosis, embolism, Adult Respiratory Distress Syndrome (ARDS), Multiple Organ Failure (MOF), neurological deficits, bleeding, hematoma, seroma, wound healing problems, implant loosening, implant failure, secondary displacement, and a category "Other".…”

Section: Methodsmentioning

confidence: 99%

Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

Schmal

Larsen

Stuby

et al. 2019

Injury

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Background and purpose Unstable pelvic fractures frequently require emergency stabilization using a C-clamp or external (CC/EF) fixation. However, the effectiveness of this intervention and associated complications are still a matter of debate. Patients and methods The analysis used data available from the German Pelvic Trauma Registry to study general complications, infections and mortality after primary stabilization using CC/EF in 5,499 patients (n=957 with vs n=4,542 without). Furthermore, the subgroups with secondary surgery (n=713 vs n=1,695), and ilio-sacral screw implantation following C-clamp stabilization were evaluated (n=24 vs n=219). Calculated odds ratios were adjusted for potential confounders. Results Patients treated by CC/EF were younger (45±20 vs 62±24 years), had more C-type fractures (65% vs 28%), higher ISS (≥25 63% vs 20%) and displacement (≥3mm 81% vs 41%), and more complex fractures (32% vs 5%). These features were independent risk factors for complications (p<0.001). While mortality was reduced after CC/EF stabilization by 32% (OR 0.68 95%CI 0.49-0.95), the risk for general complications was slightly increased (OR 1.25 95% CI 1.02-1.53). In patients undergoing secondary surgery, CC/EF fixation had no influence on mortality, general complications or infections. Related to preceding C-clamp stabilization (OR 4.67 95% CI 1.06-20.64), the risk for infection increased from 3.2% to 20.8% in ilio-sacral screw fixation. Interpretation Primary stabilization of unstable pelvic fractures with C-clamp or external fixation is associated with a decreased mortality and was not an independent risk factor for complications after secondary surgery. However, the risk for infection after ilio-sacral screw fixation increased almost 5-fold after C-clamp use.

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Section: Methodsmentioning

confidence: 99%

Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

Schmal

Larsen

Stuby

et al. 2019

Injury

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“…Moreover, the relative frequency of dead was rather high in the conservatively treated group. A hidden possible positive effect of operative stabilization could be suspected as recently described in a much larger cohort [9], which, however, focused on both B- and C-type fractures. The only identified independent risk factor for mortality in this cohort of B2 fractures was injury severity, which is in line with previous publications on pelvic fractures in general [29–31].…”

Section: Discussionmentioning

confidence: 99%

“…Although the relevance of operative therapy for type B and C pelvic fracture has recently been highlighted [9], uncertainty remains regarding the role for stabilizing the subgroup of lateral compression fractures summarized as B2-type to prevent future displacement resulting in later deformity [10, 11]. This is evidenced by a recent article by Khoury et al in which it is stated that “the indications for non-operative and operative treatment of LC fractures remain unclear” [12].…”

Section: Introductionmentioning

confidence: 99%

Decision-making, therapy, and outcome in lateral compression fractures of the pelvis – analysis of a single center treatment

Zwingmann

Eberbach

Strohm

et al. 2019

BMC Musculoskelet Disord

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Background Pelvic lateral compression fractures are the most stable of the unstable fractures. Therefore, decision making regarding operative or non-operative therapy is still a matter of debate. Methods Factors, influencing decision making for therapy, were explored based on prospectively collected register data of a single Level-1 trauma center. The analysis included epidemiological records such as age and gender, and injury characterizing parameters such as degree of displacement and the Injury Severity Score (ISS). In-hospital mortality and complications served as short-term outcome variables. After matching for relevant confounders, long-term results were compared between operatively and non-operatively treated patients, evaluating the Merle d’Aubigne and the EQ. 5D-3 L scores. Results Over an 11-year period (2004–14), 134 patients suffered from lateral compression fractures out of 567 pelvic fractures (33%). After excluding patients with clear indications for operation (complex pelvic fractures and pubic symphysis ruptures) and pediatric fractures, 114 patients could be included in the analysis. Sixty-one patients were treated conservatively (54%), 53 with an operation (46%). The operated patients were younger (43.7 vs 58.3 years), had higher ISS (19.9 vs 15.5 points) and fracture displacements (2.3 vs 4.9 mm) ( p < 0.001 for all). The length of hospital stay was shorter in the conservatively treated group (12.7 vs 17.3 days, p < 0.02). Although the types of complications were different, the incidence was not. The mortality was less in the operated group (1.9% vs. 6.6%), however, a logistic regression analysis showed that only the ISS was an independent risk factor, but not the type of therapy. Merle d’Aubigne and EQ. 5D-3 L scores were not different in the matched cohorts. Conclusion Decision-making for operative therapy was favored in severely injured young patients with high displacement. However, short- and long-term outcomes showed no difference between operatively and non-operatively treated patients. Trial registration DRKS, no. 00000488 . Registered 14th July 2010 - Retrospectively registered

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“…A more major surgical procedure could be considered for patients in whom the fracture type was upgraded from II and IV following MRI. According to this, type IV fractures would be treated with a combined anterior and posterior procedure, if necessary with combined dorsal osteosynthesis (iliolumbar fixation, iliosacral screws, possibly cement-augmented) [17,18].…”

Section: Therapeutic Relevance Of the Mrimentioning

confidence: 99%

Magnetic Resonance Imaging in Pelvic Fractures – Part 2: Gaining Information and Clinical Therapeutic Relevance

Hackenbroch¹,

Merz²,

Palm³

et al. 2019

Z Orthop Unfall

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Background Magnetic resonance and computed tomography (MRI, CT) has been known to compare the sensitivity for the detection of pelvic fractures with others. It is unclear whether MRI imaging beyond CT leads to therapy change. The aim of our study is to determine the information gained from MRI in the diagnosis of pelvic fractures and to reduce the effects on the form of therapy. Patients and Methods In a retrospective, clinical study, 31 patients with pelvic fracture and CT and MRI imaging (median 81 ± 20 years, 22 female and 9 male) were examined. There was a classification according to AO classification for adequate or FFP classification for inadequate fractures. In addition, vascular, muscular, haematomatous and organic concomitant injuries as well as bone marrow edema and additional secondary findings requiring evaluation were evaluated. The type of therapy (conservative vs. surgical) and a possible type of therapy change were documented for each patient. Exact test according to Fisher was tested orienting. Results Overall, MRI showed a greater fracture rate of pelvic fractures in 29% (n = 9) patients than CT. Four type I fractures according to FFP classification were identified as type II fractures and 4 type II fractures as type IV fractures. One type B1 fracture according to AO classification was found to be C2 fracture on MRI. Fisherʼs Exact Test found that the parameters “adequacy of trauma” and “fracture type change” by MRI were p = 0.38. MRI showed a total of 82 concomitant injuries, CT 31. Overall, MRI gained information in 75% (n = 24) of all patients examined. A change from conservative to operative after MRI took place in 2 patients. No patient was surgically changed from planned surgery to conservative. The extent to which MRI caused changes within one form of therapy (conservative, operative) could not be determined retrospectively. In 18% of patients with an inadequate fracture, however, according to the literature, the treatment regimen would have changed pro forma. Conclusion In summary, it can be stated that the MRI in our study provided an information gain in the case of adequate and inadequate pelvic fractures as well as their accompanying injuries and that a possible therapeutic relevance of this information gain could be obtained specially at the inadequate fractures showed.

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Evaluation of strategies for the treatment of type B and C pelvic fractures

Abstract: Operative stabilization is recommended for non-complex unstable pelvic fractures. The need for anterior fixation of obturator ring fractures should, however, be considered critically. Cite this article: Bone Joint J 2018;100-B:973-83.

Cited by 22 publications

References 21 publications

Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

Effectiveness and complications of primary C-clamp stabilization or external fixation for unstable pelvic fractures

Decision-making, therapy, and outcome in lateral compression fractures of the pelvis – analysis of a single center treatment

Magnetic Resonance Imaging in Pelvic Fractures – Part 2: Gaining Information and Clinical Therapeutic Relevance

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