Validated Radiographic Scoring System for Lateral Compression Type 1 Pelvis Fractures.

Abstract

To develop a radiographic fracture scoring system for lateral compression type 1 (LC-1) pelvic fractures based on OTA/AO survey data and to preliminarily evaluate this system within an LC-1 pelvis fracture cohort. Survey study with validation patient cohort. Two Level 1 academic trauma centers. Attendings (n=111) at the 2013 OTA/AO national meeting reviewed imaging from 27 LC-1 fractures and indicated surgical recommendations ("yes/no"). A separate LC-1 fracture cohort (33 patients) was used to evaluate the scoring system. The LC-1 scoring system (range: 5-14) based on radiographic morphology of sacral, superior ramus (SR), and inferior ramus (IR) fracture components. Numeric scores were compared against (1) OTA/AO attendees' operative recommendations and (2) LC-1 cohort treatment and outcomes. Operative tendency of OTA/AO survey respondents-defined as the percent of "yes" responses to recommend surgical stabilization-was highly correlated with radiographic findings: sacral displacement {odds ratio (OR) = 18.9 [95% confidence interval (CI): 11.7-30.6]}; sacral column 2-3 versus 1 [OR = 5.7 (95% CI: 3.9-8.3)]; Denis classification [OR = 10 (95% CI: 6.7-14.9); IR displacement OR = 3.4 (95% CI: 2.3-4.8)]; and SR fracture [OR = 1.9 (95% CI: 1.3-2.8)]. Total scores <7 were 81% accurate in predicting nonoperative treatment. Total scores >9 were 89% accurate in predicting an operative recommendation. In the LC-1 cohort, scoring accuracy was 100% (95% CI: 85%-100%). Based on survey results and patient cohort data, scores <7 predict nonoperative treatment recommendation, scores >9 indicate surgical recommendations, and scores 7-9 indicate indeterminate stability that should be further evaluated.