Distribution of Pelvic Fractures in Racing and Non-racing Sport Horses: A Retrospective Study of 86 Cases Examined in a Referral Centre

Objective The aim of this study was to analyse the pelvic fracture distribution and location in a referral centre caseload. Materials and Methods Medical records of 6,717 horses examined in a referral centre over a 7-year period were reviewed to identify all horses diagnosed with a pelvic fracture. Eighty-six horses were identified and divided into three disciplines, namely Thoroughbred racehorses (TBR), Standardbred trotter racehorses (STR) and non-racing sport horses (NRSH). Results A pelvic fracture was diagnosed in 1.3% of the cases examined during the study period. Prevalence was significantly higher in TBR (4.2%) and, regardless of the discipline, in horses under the age of 6 years (2.2%) (p < 0.01). STR were significantly younger than TBR and NRSH at the time of fracture (median ages = 1, 3 and 4 years old, respectively; p < 0.01). The fractures occurred most frequently in the ilium (44/86). No ilial wing fractures were diagnosed in STR and isolated acetabular fractures were only diagnosed in foals and yearlings. Fatigue fractures were diagnosed in TBR alone, affecting 9/22 TBR (foals and yearlings excluded) and most often located in the ilial wing (7 fatigue fractures out of the 12 ilial wing fractures) (p < 0.01). The median age of horses suffering from a pelvic fatigue fracture was 4 years. Clinical Significance This study confirms that young horses (under the age of 6 years) as well as TBR are likely to be at higher risk of a pelvic fracture. Fatigue fractures of the ilial wing seem to be a rare condition in STR while they are more frequent in young TBR in training.

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Outcome of Pelvic Fractures Identified in 75 Horses in a Referral Centre: A Retrospective Study

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0039-1688774 ◽

2019 ◽

Vol 32 (04) ◽

pp. 274-281 ◽

Cited By ~ 2

Author(s):

Claire H. Moiroud ◽

Virginie Coudry ◽

Jean-Marie Denoix

Keyword(s):

Pelvic Fracture ◽

Pelvic Fractures ◽

Internet Survey ◽

Prognostic Indicators ◽

Referral Centre ◽

Multiple Fractures ◽

Fracture Location ◽

Long Term Follow Up ◽

Study Population ◽

Competition Discipline

Objective The aim of this study was to evaluate the reliability of fracture location and horse sporting discipline as prognostic indicators after a pelvic fracture in a referral centre caseload. Materials and Methods Data were collected for the short- and long-term follow-up of all cases with a diagnosis of pelvic fracture in a 7-year period. Information was obtained for 75 horses through a postal and internet survey. The proportion of horses returning to competition following fractures was compared between groups according to the competition discipline and the characteristics of the fracture. Results Forty-six of 75 horses returned to or began their intended activity. This proportion was significantly lower in the group of horses that sustained a comminuted fracture irrespective of the fracture location (11/25, p = 0.05). The proportion of Standardbred trotter racehorses returning to a sporting career after pelvic fracture (9/20) was not significantly different from horses competing in other disciplines (37/55). Cases of multiple pelvic fractures in the study population, and particularly those involving the acetabulum, had the worst sports prognosis (2/8 and 0/4). Nevertheless, two foals and one yearling (3/5) with isolated fracture of the acetabulum went on to race. Clinical Significance A clear characterization of the fracture is essential for prognosis, as comminuted fractures seem to entail a poorer athletic prognosis. Despite a lack of significance, prognosis seems poorer for Standardbred trotter racehorses and for cases with acetabulum involvement in multiple fractures. These results should be confirmed in larger samples.

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Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

International Orthopaedics ◽

10.1007/s00264-021-05153-8 ◽

2021 ◽

Author(s):

Giuseppe Rovere ◽

Andrea Perna ◽

Luigi Meccariello ◽

Domenico De Mauro ◽

Alessandro Smimmo ◽

...

Keyword(s):

Sexual Dysfunction ◽

Sexual Function ◽

Pelvic Fracture ◽

Pelvic Ring ◽

Pelvic Fractures ◽

Sexual Dysfunctions ◽

Fracture Type ◽

Ring Fracture ◽

Male And Female ◽

Pelvic Ring Injuries

Abstract Introduction Pelvic ring injuries, frequently caused by high energy trauma, are associated with high rates of morbidity and mortality (5–33%), often due to significant blood loss and disruption of the lumbosacral plexus, genitourinary system, and gastrointestinal system. The aim of the present study is to perform a systematic literature review on male and female sexual dysfunctions related to traumatic lesions of the pelvic ring. Methods Scopus, Cochrane Library MEDLINE via PubMed, and Embase were searched using the keywords: “Pelvic fracture,” “Pelvic Ring Fracture,” “Pelvic Ring Trauma,” “Pelvic Ring injury,” “Sexual dysfunction,” “Erectile dysfunction,” “dyspareunia,” and their MeSH terms in any possible combination. The following questions were formulated according to the PICO (population (P), intervention (I), comparison (C), and outcome (O)) scheme: Do patients suffering from pelvic fracture (P) report worse clinical outcomes (C), in terms of sexual function (O), when urological injury occurs (I)? Is the sexual function (O) influenced by the type of fracture (I)? Results After screening 268 articles by title and abstract, 77 were considered eligible for the full-text analysis. Finally 17 studies that met inclusion criteria were included in the review. Overall, 1364 patients (902 males and 462 females, M/F ratio: 1.9) suffering from pelvic fractures were collected. Discussion Pelvic fractures represent challenging entities, often concomitant with systemic injuries and subsequent morbidity. Anatomical consideration, etiology, correlation between sexual dysfunction and genitourinary lesions, or pelvic fracture type were investigated. Conclusion There are evidences in the literature that the gravity and frequency of SD are related with the pelvic ring fracture type. In fact, patients with APC, VS (according Young-Burgess), or C (according Tile) fracture pattern reported higher incidence and gravity of SD. Only a week association could be found between GUI and incidence and gravity of SD, and relationship between surgical treatment and SD. Electrophysiological tests should be routinely used in patient suffering from SD after pelvic ring injuries.

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Management of Complex Pelvic Fracture with Associated Both Column Acetabular Fracture Judet-Letournel Type and a Coccygeal Fracture in a Severe Polytrauma Patient

Case Reports in Orthopedic Research ◽

10.1159/000515563 ◽

2021 ◽

pp. 192-201

Author(s):

Jessica Fiolin ◽

Ludwig Andre Powantia Pontoh ◽

Ismail Hadisoebroto Dilogo

Keyword(s):

Pelvic Fracture ◽

Hypovolemic Shock ◽

Stable Condition ◽

Acetabular Fractures ◽

Advanced Technique ◽

Operative Strategy ◽

Ilioinguinal Approach ◽

Outcome Score ◽

Satisfactory Outcome ◽

Sacroiliac Joint Disruption

Comprehensive emergency managements and early stabilization are pivotal upon treating complex pelvic and acetabular fractures. A thorough operative strategy is required to determine the best operative approach based on the patient’s general condition, available facilities, and surgeon preferences in such complex fracture configuration. Advanced technique of the fixation is necessary during a skillful execution of surgery in order to achieve good treatment results. An 18-years-old female crushed by a bus upon crossing street, presented with hypovolemic shock with ISS polytrauma score 50 consisting of right acetabular associated both column fracture, bilateral pelvic fracture anteroposterior compression type 3, and coccygeal fracture with bilateral drop foot. She underwent emergency laparotomy, had her ovary, bladder, and intestine primarily sutured, and then we immobilized the pelvic using anterior frame external fixator, which was maintained for 6 days. Upon stable condition, we performed right ilioinguinal approach and modified Stoppa with lateral window for the left side, while Kocher-Langenbeck technique was used to approach the posterior acetabular column. Postoperative radiology showed an adequate internal fixation in both right acetabular columns, successful reconstruction of pelvic ring which was fixated the left ischium, left superior and inferior pubic rami, and full restoration of left sacroiliac joint disruption. Majeed pelvic outcome score was 54, while Hannover pelvic outcome score was good and the patient was able to sit without pain 2 months postoperative. Management of complex pelvic-acetabular-coccygeal fracture requires a holistic chain of treatment by emphasizing the prompt emergency management, accurate preoperative planning, and excellent execution of reconstructive surgical strategy to achieve satisfactory outcome.

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Comparison of One-Year Functional Outcomes and Quality of Life between Posterior Pelvic Ring Fixation and Combined Anterior-Posterior Pelvic Ring Fixation after Lateral Compression (B2 Type) Pelvic Fracture

Medicina ◽

10.3390/medicina57030204 ◽

2021 ◽

Vol 57 (3) ◽

pp. 204

Author(s):

Giedrius Petryla ◽

Valentinas Uvarovas ◽

Rokas Bobina ◽

Jaunius Kurtinaitis ◽

Roma Puronaitė ◽

...

Keyword(s):

Quality Of Life ◽

Pelvic Fracture ◽

Functional Outcomes ◽

Pelvic Ring ◽

Pelvic Fractures ◽

Posterior Pelvic Ring ◽

Sf 36 ◽

One Year ◽

Anterior Posterior

Background and Objectives: The treatment algorithm of lateral compression B2 type pelvic fractures are still under debate. Some authors advocate conservative treatment, while others recommend surgical approach. The clear indications for isolated anterior or posterior ring fixation or combined anterior-posterior pelvic ring fixation of B2 type fractures remain unclear. The aim of this study was to compare the functional outcomes and quality of life after isolated posterior pelvic ring fixation and combined anterior-posterior pelvic ring fixation for the treatment of B2 pelvic fractures. Materials and Methods: Patients aged 18 to 65 years with B2 type pelvic fracture hospitalized in a single trauma centre over a period of 3 years were included in the research. Based on the attending surgeon’s preference, patients were treated with isolated posterior or combined anterior-posterior pelvic fixation. The quality of life and pelvic function were assessed using SF-36 and Majeed questionnaires, respectively. Patients filled in the questionnaires twice: during the first hospitalization (concerning their pre-trauma state—timepoint I) and one-year after the injury (timepoint II). Results: A cohort of 32 patients with B2 type pelvic fracture was enrolled in the analysis: 23 (72%) were female and 9 (28%) were male. The mean age was 35.3 ± 11.9 years. In this cohort 13 (41%) patients underwent isolated posterior pelvic ring fixation (group I) and 19 (59%) patients underwent combined anterior-posterior pelvic ring fixation (group II). No statistically significant differences were observed between the groups in both timepoints concerning Majeed, SF-36 PCS and MCS scores. However, in both groups Majeed and SF-36 PCS scores were statistically significantly lower one year after pelvic fracture compared with pre-trauma state, while SF-36 MCS scores did not differ. Conclusions: No differences were found in quality of life and functional outcomes between isolated posterior pelvic ring fixation and combined anterior-posterior fixation for the treatment of B2 type pelvic fractures.

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Emergency Management of Complicated Jejunal Diverticulosis

The American Surgeon ◽

10.1177/000313481408000625 ◽

2014 ◽

Vol 80 (6) ◽

pp. 600-603 ◽

Cited By ~ 6

Author(s):

Kevin N. Johnson ◽

Grant T. Fankhauser ◽

Alyssa B. Chapital ◽

Marianne V. Merritt ◽

Daniel J. Johnson

Keyword(s):

Emergency Management ◽

Medical Records ◽

Surgical Intervention ◽

Nonoperative Management ◽

Bowel Perforation ◽

Rare Condition ◽

Traditional Management ◽

Tertiary Referral Center ◽

Presenting Symptoms ◽

Jejunal Diverticulosis

Jejunal diverticulosis is a rare condition that is usually found incidentally. It is most often asymptomatic but presenting symptoms are nonspecific and include abdominal pain, nausea, diarrhea, malabsorption, bleeding, obstruction, and/or perforation. A retrospective review of medical records between 1999 and 2012 at a tertiary referral center was conducted to identify patients requiring emergency management of complicated jejunal diverticulosis. Complications were defined as those that presented with inflammation, bleeding, obstruction, or perforation. Eighteen patients presented to the emergency department with acute complications of jejunal diverticulosis. Ages ranged from 47 to 86 years (mean, 72 years). Seven patients presented with evidence of free bowel perforation. Six had either diverticulitis or a contained perforation. The remaining five were found to have gastrointestinal bleeding. Fourteen of the patients underwent surgical management. Four patients were successfully managed nonoperatively. As a result of the variety of presentations, complications of jejunal diverticulosis present a diagnostic and therapeutic challenge for the acute care surgeon. Although nonoperative management can be successful, most patients should undergo surgical intervention. Traditional management dictates laparotomy and segmental jejunal resection. Diverticulectomy is not recommended as a result of the risk of staple line breakdown. The entire involved portion of jejunum should be resected when bowel length permits.

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Military experience in the management of pelvic fractures from OIF/OEF

BMJ Military Health ◽

10.1136/bmjmilitary-2020-001469 ◽

2020 ◽

pp. bmjmilitary-2020-001469

Author(s):

William Parker ◽

R W Despain ◽

J Bailey ◽

E Elster ◽

C J Rodriguez ◽

...

Keyword(s):

Lower Extremity ◽

Pelvic Fracture ◽

External Fixator ◽

Injury Severity ◽

Fracture Pattern ◽

Injury Pattern ◽

Pelvic Fractures ◽

Vertical Shear ◽

Treatment Modalities ◽

Pelvic Binder

IntroductionPelvic fractures are a common occurrence in combat trauma. However, the fracture pattern and management within the most recent conflicts, i.e. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), have yet to be described, especially in the context of dismounted complex blast injury. Our goal was to identify the incidence, patterns of injury and management of pelvic fractures.MethodsWe conducted a retrospective review on all combat-injured patients who arrived at our military treatment hospital between November 2010 and November 2012. Basic demographics, Young-Burgess fracture pattern classification and treatment strategies were examined.ResultsOf 562 patients identified within the study time period, 14% (81 of 562) were found to have a pelvic fracture. The vast majority (85%) were secondary to an improvised explosive device. The average Injury Severity Score for patients with pelvic fracture was 31±12 and 70% were classified as open. Of the 228 patients with any traumatic lower extremity amputation, 23% had pelvic fractures, while 30% of patients with bilateral above-knee amputations also sustained a pelvic fracture. The most common Young-Burgess injury pattern was anteroposterior compression (APC) (57%), followed by lateral compression (LC) (36%) and vertical shear (VS) (7%). Only 2% (nine of 562) of all patients were recorded as having pelvic binders placed in the prehospital setting. 49% of patients with pelvic fracture required procedural therapy, the most common of which was placement of a pelvic external fixator (34 of 40; 85%), followed by preperitoneal packing (16 of 40; 40%) and angioembolisation (three of 40; 0.75%). 17 (42.5%) patients required combinations of these three treatment modalities, the majority of which were a combination of external fixator and preperitoneal packing. The likelihood to need procedural therapy was impacted by injury pattern, as 72% of patients with an APC injury, 100% of patients with a VS injury and 25% of patients with an LC injury required procedural therapy.ConclusionsPelvic fractures were common concomitant injuries following blast-induced traumatic lower extremity amputations. APC was the most common pelvic fracture pattern identified. While procedural therapy was frequent, the majority of patients underwent conservative therapy. However, placement of an external fixator was the most frequently used modality. Considering angioembolisation was used in less than 1% of cases, in the forward deployed military environment, management should focus on pelvic external fixation±preperitoneal packing. Finally, prehospital pelvic binder application may be an area for further process improvement.

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Pelvic Fractures

Acta Radiologica ◽

10.1177/028418519403500504 ◽

1994 ◽

Vol 35 (5) ◽

pp. 420-425 ◽

Cited By ~ 5

Author(s):

J. Albrechtsen ◽

J. Hede ◽

A. G. Jurik

Keyword(s):

Femoral Head ◽

Pelvic Ring ◽

Posterior Part ◽

Conventional Radiography ◽

Pelvic Fractures ◽

Acetabular Fractures ◽

Pelvic Ring Fractures

Sixty-two patients with pelvic fractures were evaluated by conventional radiography and CT. A correct pathoanatomic classification of the fractures was most often obtained by conventional radiography, but CT added information regarding acetabular fractures and involvement of the posterior part of the pelvic ring. Besides, CT was essential in the detection of intraarticular fragments and lesions of the femoral head. Classification of pelvic ring fractures by the pattern of traumatic forces was easily obtainable by conventional radiography, but often difficult to achieve by CT.

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The Effect of Displaced Versus Nondisplaced Pelvic Fractures on Long-Term Racing Performance in 31 Thoroughbred Racehorses

Equine Veterinary Journal ◽

10.1111/evj.12145_14 ◽

2013 ◽

Vol 45 ◽

pp. 6-6

Author(s):

S.E. Hennessy ◽

M.A. Muurlink ◽

G.A. Anderson ◽

T.N. Puksmann ◽

R.C. Whitton

Keyword(s):

Pelvic Fractures ◽

Racing Performance ◽

Thoroughbred Racehorses

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88 The Truth Behind the Pubic Rami Fracture: Identification of Pelvic Fragility Fractures at A University Teaching Hospital

Age and Ageing ◽

10.1093/ageing/afz193.03 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i28-i29

Author(s):

D van Berkel ◽

O Herschkovich ◽

R Taylor ◽

T Ong ◽

O Sahota

Keyword(s):

Older People ◽

Pelvic Fracture ◽

Plain Radiograph ◽

Fragility Fractures ◽

University Teaching ◽

Acetabular Fractures ◽

Sacral Fractures ◽

Pubic Rami ◽

Number Of Patients ◽

Pelvic Imaging

Abstract Introduction Older patients presenting with pelvic fragility fractures (PFF) is an increasing epidemic. The most common pelvic fracture identified by plain radiograph is pubic rami fracture. These fractures are painful and often require admission to hospital. However, despite optimal analgesia, many of these patients struggle to mobilise and may have fractures of the posterior pelvic ring, which are overlooked and not visible on plain radiograph imaging. We aimed to quantify the number of patients progressing to further pelvic imaging in the form of computed tomography (CT) or magnetic resonance imaging (MRI) and the presence of concurrent fractures. Methods Prospective screening of pelvic imaging in patients aged over 70 years was undertaken at Nottingham University Hospitals NHS Trust over an 8-month period from October 2018. Results 103 predominantly female (83%) patients were confirmed to have an acute fragility fracture of the pubic rami on plain radiograph. 19% of patients were discharged direct from the Emergency Department, 45% were admitted to Health Care of Older People (HCOP) teams, 30% to Trauma and Orthopaedic (T&O) teams and 6% to other specialities. 25% of the patients admitted underwent further pelvic imaging, which confirmed fragility fractures of the pubic rami in 88%, with 40% showing acetabular fractures and 68% showing sacral fractures of all types. A further 10 patients were diagnosed with pubic rami insufficiency fractures on further imaging, having had a normal initial radiograph, but had been admitted with poor mobility due to groin pain. In these 10 patients, 20% also had an acetabular fracture and 60% sacral fractures. Overall, 59% of patients with pubic rami fractures had an ipsilateral sacral fracture; a Type 1 Lateral Compression pelvic fracture by AO classification. Conclusions Pubic rami fractures are a significant problem in older people and often require admission to hospital. Further imaging confirms these fractures are complex, with co-existing fractures of the acetabulum and sacrum common. However despite this, only a quarter of patients admitted had further imaging. Where pelvic fractures are missed or severity not appreciated, appropriate pain control can be more difficult to achieve. With the potential for minimally invasive surgical options to aid pain management in sacral fractures, it may be prudent for all patients hospitalised with suspected or confirmed pelvic fracture to undergo further imaging.

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Pre-hospital and emergency department management of pelvic fractures and major trauma centre status: Has practice changed?

Trauma ◽

10.1177/1460408616677562 ◽

2016 ◽

Vol 19 (3) ◽

pp. 207-211

Author(s):

Jonathan Barnes ◽

Philip Thomas ◽

Ramsay Refaie ◽

Andrew Gray

Keyword(s):

Emergency Department ◽

Clinical Practice ◽

Pelvic Fracture ◽

Major Trauma ◽

High Energy ◽

Trauma Centre ◽

Pelvic Fractures ◽

Major Trauma Centre ◽

Initial Imaging ◽

One Year

Introduction Pelvic fractures are indicative of high-energy injuries and carry a significant morbidity and mortality and pelvic binders are used to stabilise them in both the pre-hospital and emergency department setting. Our unit gained major trauma centre status in April 2012 as part of a national programme to centralise trauma care and improve outcomes. This study investigated whether major trauma centre status led to a change in workload and clinical practice at our centre. Methods A retrospective analysis of all patients admitted with a pelvic fracture for the six-month periods before, after and at one-year following major trauma centre status designation. Data were retrospectively collected from electronic patient records and binder placement assessed using an accepted method. Patients with isolated pubic rami fractures were excluded. Results Overall, 6/16 (37.5%) pelvic fracture admissions had a binder placed pre-major trauma centre status, rising to 14/34 (41.2%) immediately post-major trauma centre status and 22/32 (68.8%) ( p = 0.025) one year later. Binders were positioned accurately in 4 patients (80%, one exclusion) pre-major trauma centre status, 12 (92.4%) post-major trauma centre status and 22 (100%) at one year. CT imaging was the initial imaging used in 9 (56.3%) patients pre-major trauma centre status, 29 (85.3%) ( p = 0.04) post-major trauma centre status and 27 (84.4%) at one year. Discussion Pelvic fracture admissions doubled following major trauma centre status. Computed tomography, as the initial imaging modality, increased significantly with major trauma centre status, likely a reflection of the increased resources made available with this change. Although binder application rates did not change immediately, a significant improvement was seen after one year, with binder accuracy increasing to 100%. This suggests that although changes in clinical practice often do not occur immediately, with the increased infrastructure and clinical exposure afforded through centralisation of trauma services, they will occur, ultimately leading to improvements in trauma patient care.

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