A retrospective study about functional outcome and quality of life after surgical fixation of insufficiency pelvic ring injuries

Background Fragility fractures without significant trauma of the pelvic ring in older patients were often treated conservatively. An alternative treatment is surgery involving percutaneous screw fixation to stabilize the posterior pelvic ring. This surgical treatment enables patients to be mobilized quickly and complications associated with bedrest and temporary immobility are reduced. However, the functional outcome following surgery and quality of life of the patients have not yet been investigated. Here, we present a comprehensive study addressing the long-term well-being and the quality of life of patients with fragility pelvic ring fractures after surgical treatment. Methods Between 2011–2019, 215 geriatric patients with pelvic ring fractures were surgically treated at the university hospital in Göttingen (Germany). Of these, 94 patients had fragility fractures for which complete sets of computer tomography (CT) and radiological images were available. Fractures were classified according to Tile and according to the FFP classification of Rommens and Hofmann. The functional outcome of surgical treatment was evaluated using the Majeed pelvic score and the Short Form Health Survey-36 (SF-36). Results Thirty five tile type C and 48 type B classified patients were included in the study. After surgery eighty-three patients scored in average 85.92 points (± 23.39) of a maximum of 100 points using the Majeed score questionnaire and a mean of 1.60 points on the numerical rating scale ranging between 0 and 10 points where 0 points refers to “no pain” and 10 means “strongest pain”. Also, the SF-36 survey shows that surgical treatment positively effects patients with respect to their general health status and by restoring vitality, reducing bodily pain and an increase of their general mental health. Conclusions Patients who received a percutaneous screw fixation of fragility fractures of the posterior pelvic ring reported an overall positive outcome concerning their long-term well-being. In particular, older patients appear to benefit from surgical treatment. Trial registration Functional outcome and quality of life after surgical treatment of fragility fractures of the posterior pelvic ring, DRKS00024768. Registered 8th March 2021 - Retrospectively registered. Trial registration number DRKS00024768.

OF-Pelvis classification of osteoporotic sacral and pelvic ring fractures

Objectives Osteoporotic fractures of the pelvis (OFP) are an increasing issue in orthopedics. Current classification systems (CS) are mostly CT-based and complex and offer only moderate to substantial inter-rater reliability (interRR) and intra-rater reliability (intraRR). MRI is thus gaining importance as a complement. This study aimed to develop a simple and reliable CT- and MRI-based CS for OFP. Methods A structured iterative procedure was conducted to reach a consensus among German-speaking spinal and pelvic trauma experts over 5 years. As a result, the proposed OF-Pelvis CS was developed. To assess its reliability, 28 experienced trauma and orthopedic surgeons categorized 25 anonymized cases using X-ray, CT, and MRI scans twice via online surveys. A period of 4 weeks separated the completion of the first from the second survey, and the cases were presented in an altered order. While 13 of the raters were also involved in developing the CS (developing raters (DR)), 15 user raters (UR) were not deeply involved in the development process. To assess the interRR of the OF-Pelvis categories, Fleiss’ kappa (κF) was calculated for each survey. The intraRR for both surveys was calculated for each rater using Kendall’s tau (τK). The presence of a modifier was calculated with κF for interRR and Cohen’s kappa (κC) for intraRR. Results The OF-Pelvis consists of five subgroups and three modifiers. Instability increases from subgroups 1 (OF1) to 5 (OF5) and by a given modifier. The three modifiers can be assigned alone or in combination. In both surveys, the interRR for subgroups was substantial: κF = 0.764 (Survey 1) and κF = 0.790 (Survey 2). The interRR of the DR and UR was nearly on par (κF Survey 1/Survey 2: DR 0.776/0.813; UR 0.748/0.766). The agreement for each of the five subgroups was also strong (κF min.–max. Survey 1/Survey 2: 0.708–0.827/0.747–0.852). The existence of at least one modifier was rated with substantial agreement (κF Survey 1/Survey 2: 0.646/0.629). The intraRR for subgroups showed almost perfect agreement (τK = 0.894, DR: τK = 0.901, UR: τK = 0.889). The modifier had an intraRR of κC = 0.684 (DR: κC = 0.723, UR: κC = 0.651), which is also considered substantial. Conclusion The OF-Pelvis is a reliable tool to categorize OFP with substantial interRR and almost perfect intraRR. The similar reliabilities between experienced DRs and URs demonstrate that the training status of the user is not important. However, it may be a reliable basis for an indication of the treatment score.

Clinical and Patient-Related Outcome After Stabilization of Dorsal Pelvic Ring Fractures: A Retrospective Study Comparing Transiliac Fixator (TIFI) and Spinopelvic Fixation (SPF)

Purpose: Aim of this retrospective cohort study was the comparison of the transiliac fixator (TIFI) and spinopelvic fixation (SPF) for fixation of dorsal pelvic ring fractures in terms of clinical outcome, complications, and quality of life.Methods: Thirty-eight patients (23 men, 15 women; mean age 47 ± 19 years) with dorsal pelvic ring fractures (type-C-injuries after AO/OTA) that have been stabilized by either TIFI (group TIFI, n = 22) or SPF (group SPF, n = 16) between May 2015 and December 2018 were retrospectively reviewed. Outcome measurements included demographic data, perioperative parameters, and complications and were obtained from the medical information system. Quality of life was assessed using the German version of the short form 36 (SF-36) and short muskuloskeletal function assessment (SMFA-D). Clinical results were assessed using Merle d'Aubigné-Score, Iowa Pelvic Score, and Majeed Pelvic Score.Results: Both groups show relatively good post-operative results, which has previously been reported. Quality of life was comparable in both groups. Group TIFI was slightly superior regarding complication rates, cutting/suture time, and fluoroscopy time. Group SPF seemed to be superior regarding pain and pelvic scores.Conclusion: None of the methods could demonstrate significant superiority over the other. Management of pelvic injuries remains a highly individual challenge adapted to the individual patients' condition. Nevertheless, if fractures allow for stabilization with TIFI, the use of this method should be taken into consideration as a less invasive and more tissue-conserving approach.

‘Within Ring’ Concept Treatment for Displaced H-Shaped Type IVb Fragility Fractures of the Pelvis

Introduction. Sacroiliac rod fixation (SIRF) preserves the mobility of L5/S1 (lumber in the pelvis), as a surgical procedure for high-energy pelvic ring fractures. The concept of SIRF method without pedicle screws into L4 and L5 is called ‘within ring’ concept. Case Presentation. We report here the clinical results of ‘within ring’ concept treatment with sacroiliac rod fixation for a case of displaced H-shaped Rommens and Hofmann classification type IVb fragility fractures of the pelvis (FFP), which A 79-year-old woman had been difficult to walk due to pain that had been prolonged for more than one month since her injury. The patient was successfully treated with SIRF, no pain waking with a walking stick and returned to most social activities including living independently within 6 months of the operation. Conclusion. SIRF is useful because it can preserve the mobility in the lumbar pelvis; not including the lumbar spine in the fixation range like spino pelvic fixation is a simple, safe, and low-invasive internal fixation method for displaced H-shaped type IVb fragility fractures of the pelvis.

NOVEL PHYSIOTHERAPEUTIC APPROACH TOWARDS A CASE OF COMPLEX MULTIPLE FRACTURE

A straddle fracture of the pelvis is a fracture of the superior and inferior pubic rami which is considered an unstable injury. Injuries most often associated with straddle fracture include sacral fracture, neurological injury, pelvic ring disturbance, lumbar spine fracture, and severe soft tissue injury. A pelvic fracture can happen through the mechanism of either moderate or medium intensity effects. This can range in magnitude from relatively minor mishaps to moderately traumatic fractures that are potentially fatal. L5 transverse process fracture are often associated with pelvic ring fractures, which may indicate high energy trauma. A 35-year-old female with a left-sided straddle fracture, a sacral ala fracture associated with an L5 transverse process fracture L5 was diagnosed by orthopaedic surgeon, on X-ray after a slip and fall sustaining injury to pelvic region, on which open reduction and internal fixation with a 5-hole pre-contoured plate was placed. Temporary reduction was done by K-wire and sacral ala fracture was fixed with 2 CC screws. Post operatively the patient had impaired limb movements and inability to perform daily activities. After operation, patient was managed with physical therapy treatment comprising of static regimens, progressing to dynamic exercises, electrotherapeutic techniques, strengthening exercises, gait exercise for duration of 10 weeks. Patient was given physiotherapy regime for 5 days per week for 10 weeks. This study shows that the operative method and timely recovery in physical therapy contributed to the progress of ROM, strength of muscle, functional activities progressively, which successfully led to further recovery.