Lateral compression type B 2-1 pelvic ring fractures in young patients do not require surgery

Höch, Andreas; Schneider, I.; Todd, Jacquelyne; Josten, Christoph; Böhme, Jörg

doi:10.1007/s00068-016-0676-3

Cited by 28 publications

(28 citation statements)

References 26 publications

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“…Nevertheless, there is a trend toward more operative treatment in recent years. 1 , 12 - 15 Nevertheless, for elderly patients, there is a lack of evidence for treatment strategies.…”

Section: Discussionmentioning

confidence: 99%

“… 1 , 11 , 12 Even in young patients, the literature is dissent about treatment strategies for lateral compression fractures. 13 - 15 For elderly patients with osteoporotic fractures, there is a paucity of data about treatment strategies to decrease comorbidity and avoid prolonged fracture healing due to osteopenia and osteoporosis. 1 , 2 , 12 Therefore, the rationale of operative surgical treatment for elderly patients is to reduce the fracture-related pain first.…”

Section: Introductionmentioning

confidence: 99%

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Outcome and 2-Year Survival Rate in Elderly Patients With Lateral Compression Fractures of the Pelvis

Höch¹,

Özkurtul²,

Pieroh

et al. 2016

Geriatr Orthop Surg Rehabil

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Introduction:Osteoporotic pelvic ring fractures are a rising problem for surgeons in industrialized countries. There is no evidence-based treatment strategy especially for lateral compression (LC) fractures involving the sacrum. The aim of this study was to evaluate and compare outcome and survival rate of nonoperative and operative treatment strategies for lateral compression fractures.Patients and Methods:In a retrospective study, 128 patients (aged ≥65 years) with an Orthopedic Trauma Association (OTA) types B2.1 and B3.3 fracture were included and analyzed regarding demographic and treatment data and adverse events. After a follow-up period of at least 2-year survival rate, quality of life and pain were evaluated using the EuroQol-5D and Short Form–12 questionnaires and the visual analog scale.Results:Fifty patients (78.3 ± 7.6 years) obtained operative treatment and 77 patients (82.7 ± 7.9 years) obtained nonoperative treatment. One died within 24 hours after admission. High rates of complications occurred in both groups (operative group: 18% and nonoperative group: 8%). Eighteen percent (14 of the 77) of conservatively treated patients needed operative treatment after discharge due to worsening pain and mobilization. The 2-year follow-up showed a high overall mortality (30%), with a significant higher survival rate for operatively treated patients (2-year survival: operatively treated 82% vs conservative 61%). No difference was found in pain and quality of life.Discussion:Elderly patients display a high rate and variety of complications and mortality in the aftermath of lateral compression fractures of the pelvis. Although a significantly higher 2-year survival rate for operatively treated patients was found, this study cannot give proof of superior position for operative treatment. Due to lacking data for alternative treatment algorithms especially for fracture-related immobilized patients, we recommended operative treatment with the aim to reduce complications related to prolonged bed rest and ensure early mobilization.

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“…Nevertheless, there is a trend toward more operative treatment in recent years. 1 , 12 - 15 Nevertheless, for elderly patients, there is a lack of evidence for treatment strategies.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcome and 2-Year Survival Rate in Elderly Patients With Lateral Compression Fractures of the Pelvis

Höch¹,

Özkurtul²,

Pieroh

et al. 2016

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

show abstract

“…Thirty-eight studies [ 8 , 9 , 25 , 26 , 28 – 30 , 32 – 36 , 10 , 37 – 44 , 46 , 47 , 11 , 48 – 54 , 56 , 18 – 22 , 24 ] used a pelvic-specific PROM, either as a single instrument or in combination with a generic PROM. Generic PROMs for physical functioning and quality of life were used in 15 studies [ 8 , 10 , 39 , 40 , 46 , 57 , 58 , 12 , 13 , 15 , 17 , 19 , 23 , 27 , 30 ]. The follow-up moment when these questionnaires were assessed ranged from six months to 15 years after the injury.…”

Section: Resultsmentioning

confidence: 99%

Patient-reported physical functioning and quality of life after pelvic ring injury: A systematic review of the literature

et al. 2020

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Background Pelvic ring injuries are one of the most serious traumatic injuries with large consequences for the patients’ daily life. During recent years, the importance of the patients’ perception of their functioning and quality of life following injury has increasingly received attention. This systematic review reports on self-reported physical functioning and quality of life after all types of pelvic ring injuries. Methods The online databases MEDLINE-PubMed and Ovid-EMBASE were searched for studies published between 2008 and 2019 to identify published evidence of patient-reported physical functioning and quality of life after which they were assessed for their methodological quality. Results Of the 2577 articles, 46 were reviewed in full-text, including 3049 patients. Most studies were heterogeneous, with small cohorts of patients, a variety of injury types, treatment methods and use of different, often non-validated, outcome measures. The overall methodological quality was moderate to poor. Nine different PROMs were used, of which the Majeed Pelvic Score (MPS), SF-36 and EQ-5D were the most widely used. Mean scores respectively ranged from 75–95 (MPS), 53–69 (SF-36, physical functioning) and 0.63–0.80 (EQ-5D). Conclusions Physical functioning and quality of life following pelvic ring injuries seem fair and tend to improve during follow-up. However, differences in patient numbers, injury definition, treatment strategy, follow-up duration and type of PROMs used between studies hampers to elucidate the actual effects of pelvic ring injuries on a patient’s life. Implications of key findings Physicians and researchers should use valid and reliable patient-reported outcome instruments on large cohorts of patients with properly defined injuries to truly evaluate physical functioning and quality of life after pelvic ring injuries. Systematic review registration number PROSPERO International prospective register of systematic reviews; registration number CRD42019129176.

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“…With a resolution of the ultrasound measuring system of 0.1 mm, we showed that the stabilization of the posterior pelvic ring with a minimally invasive tension banding achieves a comparable stability as a sacroiliac screw. The effect of a higher dislocation of the anterior pelvic fracture as seen in the FiberTape® group could also be seen in conservatively treated pelvic fractures type B 2.1 without any problems in bone healing of the anterior pelvic ring in patients under 65 years [31]. We therefore assume that the slightly increased dislocation at the anterior pelvic ring using tape suture for posterior pelvic ring stabilization is not clinically relevant.…”

Section: Discussionmentioning

confidence: 99%

Tape suture for stabilization of incomplete posterior pelvic ring fractures—biomechanical analysis of a new minimally invasive treatment for incomplete lateral compression pelvic ring fractures

et al. 2019

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Background: Incomplete lateral compression fractures (including AO Type B2.1) are among the most common pelvic ring injuries. Although the treatment of choice remains controversial, sacroiliac (SI) screws are commonly used for the operative treatment of incomplete lateral compression fractures of the pelvic ring. However, the disadvantages of SI screws include the risk of nerve root or blood vessel injury. Recently, tape sutures have been found useful as stabilizing material for the treatment of injuries of the syndesmosis, the rotator cuff and knee ligaments. In this current study, we aimed to test the biomechanical feasibility of tape sutures to stabilize the pelvis in the setting of AO Type B2.1 injury. Methods: Six human cadaveric pelvises underwent cyclic loading to compare the biomechanical stability of different osteosynthesis methods in a B2.1 fracture model. The methods tested in this experiment were a FiberTape® suture and the currently established SI screw. A 3D ultrasound tracking system was used to measure fracture fragment motion. Linear regression was used to model displacement and stiffness at the posterior and anterior pelvic ring. Results: At the posterior fracture site, the FiberTape® demonstrated similar displacement (2.2 ± 0.8 mm) and stiffness (52.2 ± 18.0 N/mm) compared to the sacroiliac screw (displacement 2.1 ± 0.6 mm, P > 0.999; stiffness 50.8 ± 13.0 N/mm, P > 0.999). Considering the anterior fracture site, the FiberTape® again demonstrated similar displacement (3.8 ± 1.3 mm) and stiffness (29.5 ± 9.0 N/mm) compared to the sacroiliac screw (displacement 2.9 ± 0.8 mm, P = 0.2196; stiffness 37.5 ± 11.5 N/mm, P = 0.0711). Conclusion: The newly presented osteosynthesis, the FiberTape®, shows promising results for the stabilization of the posterior pelvic ring in AO Type B2.1 lateral compression fractures compared to a sacroiliac screw osteosynthesis based on its minimal-invasiveness and the statistically similar biomechanical properties.

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Lateral compression type B 2-1 pelvic ring fractures in young patients do not require surgery

Abstract: Type B 2-1 pelvic ring fractures in young patients should be treated non-operatively.

Cited by 28 publications

References 26 publications

Outcome and 2-Year Survival Rate in Elderly Patients With Lateral Compression Fractures of the Pelvis

Outcome and 2-Year Survival Rate in Elderly Patients With Lateral Compression Fractures of the Pelvis

Patient-reported physical functioning and quality of life after pelvic ring injury: A systematic review of the literature

Tape suture for stabilization of incomplete posterior pelvic ring fractures—biomechanical analysis of a new minimally invasive treatment for incomplete lateral compression pelvic ring fractures

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