Analysis of pelvic fracture pattern and overall orthopaedic injury burden in children sustaining pelvic fractures based on skeletal maturity

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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A nomogram to predict arterial bleeding in patients with pelvic fractures after blunt trauma: a retrospective cohort study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02247-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Myoung Jun Kim ◽

Jae Gil Lee ◽

Eun Hwa Kim ◽

Seung Hwan Lee

Keyword(s):

Risk Factors ◽

Blunt Trauma ◽

Pelvic Fracture ◽

Bone Fractures ◽

Fracture Pattern ◽

Pelvic Fractures ◽

Pelvic Bone ◽

Cutoff Value ◽

Arterial Bleeding ◽

Independent Risk Factors

Abstract Background Pelvic bone fractures are one of the biggest challenges faced by trauma surgeons. Especially, the presence of bleeding and hemodynamic instability features is associated with high morbidity and mortality in patients with pelvic fractures. However, prediction of the occurrence of arterial bleeding causing massive hemorrhage in patients with pelvic fractures is difficult. Therefore, the aim of this study was to develop a nomogram to predict arterial bleeding in patients with pelvic bone fractures after blunt trauma. Methods The medical records of 1404 trauma patients treated between January 2013 and August 2017 were retrospectively reviewed. Patients older than 15 years with a pelvic fracture due to blunt trauma were enrolled (n = 148). The pelvic fracture pattern on anteroposterior radiography was classified according to the Orthopedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen (OTA/AO) system. Multivariable logistic regression modeling was used to determine the independent risk factors for arterial bleeding. A nomogram was constructed based on the identified risk factors. Results The most common pelvic fracture pattern was type A (58.8%), followed by types B (34.5%) and C (6.7%). Of the 148 patients, 28 (18.9%) showed pelvic arterial bleeding on contrast-enhanced computed tomography or angiography, or in the operative findings. The independent risk factors for arterial bleeding were a type B or C pelvic fracture pattern, body temperature < 36 °C, and serum lactate level > 3.4 mmol/L. A nomogram was developed using these three parameters, along with a systolic blood pressure < 90 mmHg. The area under the receiver operating characteristic curve of the predictive model for discrimination was 0.8579. The maximal Youden index was 0.1527, corresponding to a cutoff value of 68.65 points, which was considered the optimal cutoff value for predicting the occurrence of arterial bleeding in patients with pelvic bone fractures. Conclusions The developed nomogram, which was based on the initial clinical findings identifying risk factors for arterial bleeding, is expected to be helpful in rapidly establishing a treatment plan and improving the prognosis for patients with pelvic bone fractures.

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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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Application of Pelvic Circumferential Compression Devices in Pelvic Ring Fractures—Are Guidelines Followed in Daily Practice?

Journal of Clinical Medicine ◽

10.3390/jcm10061297 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1297

Author(s):

Valerie Kuner ◽

Nicole van Veelen ◽

Stephanie Studer ◽

Bryan Van de Wall ◽

Jürgen Fornaro ◽

...

Keyword(s):

Clinical Education ◽

Trauma Center ◽

Pelvic Ring ◽

Daily Practice ◽

Pelvic Trauma ◽

Fracture Pattern ◽

Pelvic Fractures ◽

Unstable Fracture ◽

Associated Injuries ◽

Resuscitation Room

Early administration of a pelvic circumferential compression device (PCCD) is recommended for suspected pelvic trauma. This study was conducted to evaluate the prevalence of PCCD in patients with pelvic fractures assigned to the resuscitation room (RR) of a Level I trauma center. Furthermore, correct application of the PCCD as well as associated injuries with potential clinical sequelae were assessed. All patients with pelvic fractures assigned to the RR of a level one trauma center between 2016 and 2017 were evaluated retrospectively. Presence and position of the PCCD on the initial trauma scan were assessed and rated. Associated injuries with potential adverse effects on clinical outcome were analysed. Seventy-seven patients were included, of which 26 (34%) had a PCCD in place. Eighteen (23%) patients had an unstable fracture pattern of whom ten (56%) had received a PCCD. The PCCD was correctly placed in four (15%) cases, acceptable in 12 (46%) and incorrectly in ten (39%). Of all patients with pelvic fractures (n = 77, 100%) treated in the RR, only one third (n = 26, 34%) had a PCCD. In addition, 39% of PCCDs were positioned incorrectly. Of the patients with unstable pelvic fractures (n = 18, 100%), more than half either did not receive any PCCD (n = 8, 44%) or had one which was inadequately positioned (n = 2, 11 %). These results underline that preclinical and clinical education programs on PCCD indication and application should be critically reassessed.

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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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PELVIC FRACTURE PATTERN PREDICTS PELVIC ARTERIAL HAEMORRHAGE

ANZ Journal of Surgery ◽

10.1046/j.1440-1622.2000.01822.x ◽

2000 ◽

Vol 70 (5) ◽

pp. 338-343 ◽

Cited By ~ 90

Author(s):

James Hamill ◽

Andrew Holden ◽

Rhondda Paice ◽

Ian Civil

Keyword(s):

Pelvic Fracture ◽

Fracture Pattern ◽

Arterial Haemorrhage

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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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Pelvic fracture pattern predicts the need for hemorrhage control intervention—Results of an AAST multi-institutional study

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2017.06.021 ◽

2017 ◽

Vol 53 (2) ◽

pp. 280

Author(s):

Stephanie Diebold

Keyword(s):

Pelvic Fracture ◽

Fracture Pattern ◽

Hemorrhage Control ◽

Control Intervention

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Non-Traumatic Tile Type B3 Pelvic Fracture Combined With Garden Type III Femoral Neck Fracture Caused By Hypocalcaemia-Induced Convulsions

10.21203/rs.3.rs-792266/v1 ◽

2021 ◽

Author(s):

Minghan Dou ◽

Guangkai Ren ◽

Baoming Yuan ◽

Chuangang Peng ◽

Dankai Wu

Keyword(s):

Femoral Neck ◽

Femoral Neck Fracture ◽

Pelvic Fracture ◽

Pelvic Fractures ◽

Maintenance Hemodialysis ◽

Tile Type ◽

Conventional Radiograph ◽

Type Iii ◽

Neck Fracture

Abstract BACKGROUND Non-traumatic fractures caused by convulsions are relatively rare and are often overlooked due to the lack of obvious evidence of injury. Non-traumatic fractures due to convulsions are diverse, but the concomitant of pelvic and femoral fractures has not been reported previously. CASE SUMMARY A 47-year-old woman with a no significant medical history, was taken to the nearest hospital after one episode of generalized tonic-clonic seizure that had occurred during sleep. After the postictal phase, the patient regained consciousness and experienced diffuse pain in the inguinal regions bilaterally with inability to stand or walk. The entire attack was witnessed by the family members who confirmed that there was not external trauma. Blood investigations revealed high creatinine and uric acid levels, along with a low calcium level. Conventional radiograph of the pelvis was performed to detect the cause of pain. The patient was noted to have a pelvic fracture and unilateral fracture of the neck of the femur. She was then transferred to our hospital for further management. The patient was diagnosed as having Tile type B3 pelvic fractures combined with a Garden type III femoral neck fracture on three-dimensional computed tomography (3D-CT). In view of her blood results, nephrology consultation was sought. The patient was identified as having a stage 5 chronic kidney disease (CKD), hypocalcemia, and hyperphosphatemia. However, neurological examination showed no abnormalities. No surgical intervention was adopted for her pelvic fractures. In addition to complete bed rest, closed reduction and percutaneous cannulated screw fixation was performed for the treatment of the right femoral neck fracture. An arteriovenous fistula was created for maintenance hemodialysis on the tenth postoperative day. At follow-up, twelve months follow-up after the operation, the patient had a normally gait and was satisfied with the outcome. CONCLUSION Patients who present with convulsive seizures especially patients with ion metabolism disorder should be examined thoroughly to ensure that no injury is missed.

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