Operative management of stress-positive minimally displaced lateral compression type 1 (LC1) pelvic ring injuries: Analysis of outcomes before and after implementation of a departmental stress protocol.

Abstract

To compare the hospital course of patients with minimally displaced (<1 cm) lateral compression type 1 (LC1) injuries treated before and after implementation of lateral stress radiographs (LSR) to determine management. Retrospective comparative cohort. Urban level one trauma centerPatients/Participants: Isolated LC1 injuries managed before (n=33) and after implementation of LSR (n=40) to determine management. Patients in a pre-stress cohort managed nonoperatively versus patients in a LSR cohort managed operatively if stress-positive (≥1cm displacement on LSR). Physical therapy (PT) clearance before discharge, discharge location, hospital length of stay (LOS), inpatient opioid morphine milligram equivalents (MME). The pre-stress and LSR protocol groups were similar in demographic/injury characteristics (age, sex, mechanism, ASA score, Nakatani classification, bilateral/unilateral injury, Denis zone, sacral fracture completeness, sacral comminution). 45.0% of LSR protocol patients were stress-positive (n=18) and managed operatively. The LSR protocol group was more likely to clear PT by discharge (97.5% vs. 75.8%, proportional difference (PD): 21.7%, 95% confidence interval (CI): 5.1% to 36.8%, p=0.009), less likely to discharge to a rehabilitation facility (2.5% vs. 18.2%, PD: -15.7%, CI: -30.0 to -0.5%, p=0.04), and had no difference in LOS (MD: 0.0, CI :-1.0 to 1.0, p=0.57) or inpatient opioid MME (MD: 9.0, CI: -60.0 to 101.0, p=0.71). Implementation of a LSR protocol to determine management of minimally displaced stress-positive LC1 injuries was associated with increased rates of operative management, PT clearance by discharge, and a reduction in the number of patients discharging to rehabilitation facilities.