Persistent Impairment After Surgically Treated Lateral Compression Pelvic Injury

Hoffmann, Martin; Jones, Clifford B.; Sietsema, Debra L.

doi:10.1007/s11999-012-2247-1

Cited by 24 publications

(36 citation statements)

References 46 publications

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“…There are many causes for pain in a polytraumatized patient. Interestingly, Hoffman et al [12] found polytraumatized patients had lower pain scores at 6 months than their counterparts with isolated pelvic fracture. We anticipated difficulty delineating which effect the pelvic injury has relative to the whole picture, but we designed a pragmatic trial to include polytraumatized patients in our study because it is more reflective of our patient population and is part of our daily clinical decision-making, therefore making our findings more generalizable.…”

Section: Discussionmentioning

confidence: 99%

Does Surgical Stabilization of Lateral Compression-type Pelvic Ring Fractures Decrease Patients’ Pain, Reduce Narcotic Use, and Improve Mobilization?

Hagen

Castillo

Dubina

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Debate remains over the role of surgical treatment in minimally displaced lateral compression (Young-Burgess, LC, OTA 61-B1/B2) pelvic ring injuries. Lateral compression type 1 (LC1) injuries are defined by an impaction fracture at the sacrum; type 2 (LC2) are defined by a fracture that extends through the posterior iliac wing at the level of the sacroiliac joint. Some believe that operative stabilization of these fractures limits pain and eases mobilization, but to our knowledge there are few controlled studies on the topic.Questions/purposes (1) Does operative stabilization of LC1 and LC2 pelvic fractures decrease patients' narcotic use and lower their visual analog scale pain scores? (2) Does stabilization allow patients to mobilize earlier with physical therapy? Methods This retrospective study of LC1 and LC2 fractures evaluated patients treated definitively at one institution from 2007 to 2013. All patients treated surgically, all nonoperative LC2, and all nonoperative LC1 fractures with complete sacral injury were included. In general, LC1 or LC2 fractures with greater than 10 mm of displacement and/or sagittal/axial plane deformity on static radiographs were treated surgically. One hundred fiftyeight patients in the LC1 group (107 [of 697 screened] nonoperative, 51 surgical) and 123 patients in the LC2 group (78 nonoperative, 45 surgical) met inclusion criteria. The surgical and nonoperative groups were matched for fracture type. To account for differences between patients treated surgically and nonoperatively, we used propensity modeling techniques incorporating treatment predictors. Propensity scores demonstrated good overlap and were used as part of multiple variable regression models to account for selection bias between the surgically treated and nonoperative groups. Patient-reported pain scores and Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the University of Maryland, Baltimore, MD, USA. Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® narcotic administration were tallied in 24-hour increments during the first 24 hours of hospitalization, at 48 hours after intervention, and in the 24 hours before discharge. Time from intervention to mobilization out of bed was recorded; intervention was defined as the date of ...

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Section: Discussionmentioning

confidence: 99%

Does Surgical Stabilization of Lateral Compression-type Pelvic Ring Fractures Decrease Patients’ Pain, Reduce Narcotic Use, and Improve Mobilization?

Hagen

Castillo

Dubina

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Other studies excluded patients who could not complete questionnaires or participate in the follow‐up, likely excluding head injured patients from their studies, and reducing the generalizability of their results. Disentangling disability associated with pelvic fracture from disability associated with other sustained injuries is challenging . We used a functional outcome instrument recommended for multi‐trauma populations.…”

Section: Discussionmentioning

confidence: 99%

Functional and return to work outcomes following major trauma involving severe pelvic ring fracture

Gabbe

Hofstee

Esser

et al. 2014

ANZ Journal of Surgery

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Background: There is limited evidence describing the long-term outcomes of severe pelvic ring fractures. The aim of this study was to describe the longer term independent living and return to work outcomes following severe pelvic ring fracture. Methods: Adult survivors to discharge from two major trauma centres with AO/Tile type B and C fractures were followed up at 6, 12 and 24-months post-injury to capture functional (Glasgow Outcome Scale-Extended [GOS-E]) and return to work data. Multivariable, mixed effects models were used to identify predictors of outcome. Results: A total of 111 of 114 (97%) cases were followed up. The mean (SD) age of participants was 41.9 (18.9) years, 77% were male, 81% were transport-related and 90% were multi-trauma patients. Further, 11% were managed conservatively, 10% with external fixation and 79% with open reduction and internal fixation. At 24 months, 77% were living independently (GOS-E > 4) and 59% had returned to work. Higher Injury Severity Scores (ISS) were associated with lower risk-adjusted odds of return to work (P = 0.04) and independent living (P = 0.06). Post-operative infection was associated with living independently (P = 0.02). Conclusion: Despite the severity of the injuries sustained, 77% of severe pelvic ring fracture patients were living independently and 59% had returned to work, 2-years post-injury. Fracture type and management were not key predictors of outcome. Large-scale multi-centre studies are needed to fully understand the burden of severe pelvic ring fractures and to guide clinical management.

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“…Furthermore, Sagi et al [7] proposed a modification of the Young and Burgess classification system for LC-1 injuries, into LC-1a (not requiring surgical treatment) and LC-1b (may require surgical treatment), based on the amount of displacement during MUA which showed that almost 40 % of LC-1 injuries are inherently unstable. The MUA was also used in a recent study to test the stability and guide the treatment of Tile Type-B fractures of the pelvis [26]. Despite the above data, there is still a debate as to whether there is a clear indication for surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Lateral Compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable?

Tosounidis

Kanakaris

Nikolaou

et al. 2012

International Orthopaedics (SICOT)

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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 painfree 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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Persistent Impairment After Surgically Treated Lateral Compression Pelvic Injury

Cited by 24 publications

References 46 publications

Does Surgical Stabilization of Lateral Compression-type Pelvic Ring Fractures Decrease Patients’ Pain, Reduce Narcotic Use, and Improve Mobilization?

Does Surgical Stabilization of Lateral Compression-type Pelvic Ring Fractures Decrease Patients’ Pain, Reduce Narcotic Use, and Improve Mobilization?

Functional and return to work outcomes following major trauma involving severe pelvic ring fracture

Assessment of Lateral Compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable?

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