Type Of Pelvic Fracture Research Articles

Risk Factors for Lumbosacral Plexus Palsy Related to Pelvic Fracture

A retrospective study. We assessed risk factors for lumbosacral plexus palsy related to pelvic fracture that can be evaluated during the acute injury phase with diagnostics such as computed tomography (CT). Many patients with pelvic fracture are in vital shock, with polytrauma and loss of consciousness, making an accurate neurologic examination very difficult in the emergency room. This study included 22 patients who had AO classification type B or C pelvic fractures. The 22 patients had 27 posterior osteoligamentary lesions. The average injury severity score (ISS) was 27.5 (range, 16-50). Age, sex, ISS, suicidal jump, longitudinal displacement, sacral transverse fracture, pubic fracture, lumbar transverse process fracture, type of pelvic fracture (AO), and type of sacral fracture (Denis) were examined for a correlation with the lumbosacral plexus palsy. Using coronal reconstruction CT, we considered a 10 mm or greater displacement at the sacrum or sacroiliac joint to be a longitudinal displacement. Transverse sacral fracture was diagnosed by sagittal reconstruction CT. Of the 22 patients, 5 (22.7%) had lumbosacral plexus palsy (8 of 27 pelvic fractures) detected during treatment. The incidence of lumbosacral plexus palsy was not related to age, sex, ISS. Incidence of palsy was significantly higher when the patient's affected side had longitudinal displacement. Patients who had made a suicidal jump or had a sacral transverse fracture also had a significantly higher risk for lumbosacral plexus palsy. Palsy was not related to the type of pelvic fracture (AO) or sacral fracture (Denis). In this study, longitudinal displacement of the pelvis, transverse sacral fracture, and trauma from a suicidal jump were risk factors for lumbosacral plexus palsy. These risk factors were helpful in our examination of patients who had severe pelvic fracture with loss of consciousness.

Pelvic Fractures Resulting from Snowboarding

Background Information regarding pelvic fractures sustained during snowboarding is scant. Purpose To analyze the epidemiologic data, injury patterns, and types of pelvic fractures sustained during snowboarding. Study Deign Case series; Level of evidence, 4. Methods We analyzed the epidemiologic factors, injury patterns, and types of pelvic fractures in 145 patients with snowboarding-related pelvic fractures who were admitted to our institution from the 1998-1999 to the 2006-2007 ski season. Results The incidence of snowboarding-related pelvic fractures was 0.102 per 10 000 ski lift tickets, which amounted to 2% of all snowboarding-related fractures (fifth most common type of fracture among all snowboarding-related fractures). Of the pelvic fractures, 85.5% were stable (type A according to the Tile classification) and 14.5% were unstable (types B and C according to the Tile classification). Isolated sacral fractures had the second-highest incidence (24.1%) after pubic bone and/or ischium fractures (46.9%). A distinct female prevalence was seen (52.4%). Jumps and isolated falls were the main mechanisms of injury (80%), and the incidence of collision was significantly higher in the unstable group than in the stable group (P = .037). In all, 57.9% patients classified their skill level as “intermediate,” and only 9.7% of patients had received professional snowboarding lessons. A total of 30 subjects (20.8%) had other injuries along with pelvic fractures; the patients with multiple injuries were significantly more frequent in the unstable group than in the stable group (P = .035). Conclusion Pelvic fractures resulting from snowboarding accidents included a higher proportion with isolated sacral fractures in the stable group and a lower prevalence of associated injuries in the unstable group compared with those resulting from other causes.

Extraperitoneal bladder rupture with severe lacerations of the urogenital diaphragm: a case report

BackgroundA 65-year woman injured by automobile had an open-book type pelvic fracture and extraperitoneal bladder rupture.Case presentationNon-surgical management was selected because of suspected minor leakage. A follow-up CT cystography on day 21 showed a large urinoma. In the sagittal reconstruction CT images, the bladder was displaced downwards. Surgery was performed. Surgical findings showed that the bladder neck and the urethra were not anchored because of a laceration in the urogenital diaphragm. The bladder base had descended to the inferior margin of the pubic bone and a laceration of about 3 cm was found in the anterior surface of the bladder neck. The laceration was sutured, and the wall of the urinoma was extensively resected. The postoperative course was uneventful.ConclusionAn extraperitoneal bladder rupture associated with a severe laceration in the urogenital diaphragm will be indicated for surgery when the bladder is not anchored and healing is prevented. Sagittal reconstruction CT cystography was effective for this diagnosis.

Risk Factors for Erectile Dysfunction in Patients with Urethral Strictures Secondary to Blunt Trauma

Erectile dysfunction (ED) is a well-known consequence of pelvic fracture, particularly in cases involving urethral injury. There are several risk factors that may be related to ED. However, no systemic approach is used to assess erectile function secondary to urethral trauma. To investigate ED associated with urethral injury secondary to pelvic fracture and perineal trauma. Forty patients with traumatic urethral strictures secondary to blunt traumatic impact episode to the pelvis or perineum were included in our study. Pelvic fractures and urethral strictures were categorized according to injury types and radiological findings. All patients underwent nocturnal penile tumescence (NPT) monitoring, dynamic color-duplex Doppler ultrasonography (D-CDDU) before surgery. NPT monitoring was conducted again after surgery. The events of NPT and D-CDDU were recorded. In all patients, 11 had organic ED demonstrated by NPT. Vascular pathology was identified in three of 11 patients (27%). The peak systolic velocity of cavernosal artery was lower in patients with pubic diastasis in comparison to those without diastasis (P < 0.05). Significant changes in penile length and circumference were noted in posterior urethral injury compared with anterior urethral injury during erection (P < 0.05). The erectile duration time has a similar statistical difference in two groups mentioned above. However, no significant difference could be observed in the end-to-end anatomosis procedure before and after surgery (P > 0.05). The pelvic fracture type, especially pubic diastasis, is a risk factor for ED following urethral injury. Location of the stricture is also a risk factor for subsequent erectile dysfunction.

Bilateral iliac artery dissection following severe complex unstable pelvic fracture

The case of an 18-year-old polytrauma patient with a complete disruption of the right external iliac artery and a dissection of the left external iliac artery mainly caused by bilateral complex pelvic fractures type C, a subluxated horizontal fracture of the right acetabulum, and a transforaminal sacrum fracture is described.

Patterns of urethral injury and immediate management

The management of urethral trauma remains controversial. The purpose of this review is to provide a concise account of the patterns of urethral injury and the current trends of its immediate management. Recent studies have identified types of pelvic fractures associated with a higher risk of urethral injury. Recognition of these fractures coupled with timely radiographic imaging has facilitated the earlier diagnosis of urethral injury and ensured that serious long-term sequelae are minimized. In highly selected cases of complete anterior and posterior urethral disruption primary realignment by a combined antegrade and retrograde endoscopic approach is increasingly being considered as a management option to restore early urethral continuity. Urethral trauma secondary to penetrating gunshot wounds and penile fracture requires immediate surgical exploration and repair. The urologist involved in the management of genitourinary tract trauma needs to recognize the patterns of urethral injury, especially those associated with certain pelvic fractures. A judicious and systematic approach coupled with a conscious effort to minimize short and long-term sequelae of all urethral injuries will ensure optimal results. There is a need for a consensus on the optimal management of each of the vast arrays of urethral injuries.

Extraperitoneal Pelvic Packing: A Salvage Procedure to Control Massive Traumatic Pelvic Hemorrhage

To describe the method of extraperitoneal pelvic packing (EPP), and to assess the impact of EPP on outcome in severely hemodynamically unstable patients after blunt pelvic trauma. Of 661 patients treated for pelvic trauma, 18 underwent EPP as part of our protocol with the intent to control massive pelvic bleeding and constituted the study population. Data retrospectively collected from the medical records and from the Ullevål Trauma Registry included demographics, fracture classification, additional injuries, blood transfusions, surgical interventions, angiographic procedure, physiologic parameters, and survival. Survival rate within 30 days was 72% (13/18), and correlated inversely to the age of the patient (p = 0.038). Only one of the nonsurvivors died of exsanguination. A significant increase in systolic blood pressure (BP) (p = 0.002) was observed immediately after EPP. Angiography performed after EPP was positive for arterial injury in 80% of patients. All types of pelvic ring fractures were represented. EPP as part of a multi-interventional resuscitation protocol might be life saving in patients with life-threatening pelvic injury who are exsanguinating. However, the high rate of arterial injuries seen after EPP indicates that the procedure should be supplemented with angiography once the patient is sufficiently stabilized to tolerate transportation to the angiography suite.

Associated Injuries and Not Fracture Instability Predict Mortality in Pelvic Fractures: A Prospective Study of 100 Patients

Whether pelvic fracture instability is correlated to mortality in blunt multiply-injured trauma patients is debatable. This is the first prospective study on patients with pelvic fractures aiming at finding whether pelvic fracture type affects mortality. There were 100 consecutive patients (77 males, mean age of 31 [3-73] years) studied between September 2003 and October 2004. Data were collected regarding mechanism of injury, associated injuries, Injury Severity Score (ISS), Revised Trauma Score, blood transfusions, and mortality. The fractures were classified according to instability, where type O is stable, type R is rotationally unstable, and type RV is both rotationally and vertically unstable. Because a pure acetabular fracture is a single break in the pelvic ring, we classified it as type O. Computer tomography was used for fracture classification in 73 patients and plain X-rays in 27 patients. There were 77 fractures caused by road traffic collisions. Type O fractures (n = 63) had lower median ISS (13 [4-48]) than type R (n = 19) (18 [9-75]) and type RV (n = 18) (18 [6-66]) (p = 0.019, Kruskall Wallis). There was no significant difference in ISS between type R and RV fractures. A logistic regression model has shown that ISS was the only significant factor that predicts mortality. ISS is the most important predictor in defining mortality in patients with pelvic fracture and not the type of pelvic instability.

Accuracy of Trauma Ultrasound in Major Pelvic Injury

Trauma ultrasound (US) utilizing the focused assessment with sonography in trauma (FAST) is often performed to detect traumatic free peritoneal fluid (FPF). Yet its accuracy is unclear in certain trauma subgroups such as those with major pelvic fractures whose emergent diagnostic and therapeutic needs are unique. We hypothesized that in patients with major pelvic injury (MPI) trauma ultrasound would perform with lower accuracy than has previously been reported. Retrospective analysis of adult trauma patients with pelvic fractures seen at an urban Level I emergency department and trauma center. Patients were identified from the institutional trauma registry and ultrasound database from 1999 to 2003. All patients aged >16 years with MPI (Tile classification A2, all type B and C pelvic fractures, and type C acetabular fractures determined by a blinded orthopedic traumatologist) and who had a trauma US performed during the initial emergency department evaluation were included. All ultrasounds were performed by emergency physicians or surgeons using the four-quadrant FAST evaluation. Results of US were compared with one of three reference standards: abdominal/pelvic computed tomography, diagnostic peritoneal tap, or exploratory laparotomy. Two-by-two tables were constructed for diagnostic indices. In all, 96 patients were eligible; 9 were excluded for indeterminate ultrasound results. Of the remaining 87 patients, the pelvic fracture types were distributed as follows: 9% type A2, 72% type B, 16% type C, and 3% type C acetabular fractures. Overall US sensitivity for detection of FPF was 80.8%, specificity was 86.9%, positive predictive value was 72.4%, and negative predictive value was 91.4%. Categorization of sensitivity according to pelvic ring fracture type is as follows: type A2 fractures: sensitivity and specificity, 75.0%; type B fractures: sensitivity, 73.3%, specificity, 85.1%; and type C fractures (pelvis and acetabulum): sensitivity and specificity, 100%. Of the true-positive US results, blood was the FPF in 16 of 21 (76%) and urine from intraperitoneal bladder rupture in 4 in 21 (19%) patients. US in the initial evaluation of traumatic peritoneal fluid in major pelvic injury patients has lower sensitivity and specificity than previously reported for blunt trauma patients. Additionally, uroperitoneum comprises a substantial proportion of traumatic free peritoneal fluid in patients with MPI.

Traumatic Pelvic Fractures

Pelvic fractures can be a big challenge in caring for the injured patient. Pelvic fractures are important as a cause for morbitidy and mortality. The mortality can be 30% with unstable pelvic ring injuries, and 10-12% of this percentage alone is due to blood loss. Multiple complications can occur during a pelvic fracture. This article will help nurses assess and manage patients with pelvic injuries. Topics covered in the article include basic anatomy of the pelvis, diagnostic tests performed after a pelvic fracture, types of pelvic fractures, management of pelvic fractures, and complications.

The floating hip injury: which should we fix first?

In floating hip injuries, the priority of the steps in fixation has not been well described. We have treated these patients in accordance with the following protocols. In patients with pelvic ring fractures, the external fixation should be performed first, and in patients with acetabular fractures, the femoral fractures should be internally fixated first. The purpose of the present study was to review our experience with these fracture treatments to evaluate our strategy. For 8 years, 31 patients with femoral fractures associated with ipsilateral fractures: 26 unstable pelvic ring fractures and 7 unstable acetabular fractures were surgically treated at our level 1 trauma center. We reviewed the admission, operation, and follow-up records retrospectively and evaluated the order of the fixation and the complications. Two patients with acetabular fractures failed to follow our protocol outlined at the preoperative planning stage. There were no surgical difficulties other than two patients with the hemipelvis dislocated proximally who required traction of the fixated femur. The complications that were thought to be related to our protocol were one fat embolism syndrome and one pubic fracture displacement. One heterotopic ossification seemed to occur due to using a single approach for both fractures. We believe our protocol to be generally effective, however, in patients with acetabular and vertical shear type pelvic ring fractures, the internal or external fixation of the femur should be performed before the internal fixation of the pelvis.

Clinical Outcome of AO Type C Pelvic Ring Injury

Purpose: To study the clinical results of AO type C pelvic ring injuries and identify the prognostic factors. Materials and Methods: 25 patients were treated for C type pelvic ring fractures between January 1995 and August 2002. The injury mechanism, associated injuries, time from injury to surgery, ICU care, Injury Severity Score, fracture site of posterior ring, displacement, surgical method, and complications were analyzed. Radiological and clinical evaluations of the results were conducted using the Majeed’s score. Of the 25 patients, 16 were male, 9 were female, with an average age of 41.6 years. All except one patient had associated injuries and 12 patients had neurological complications. There were 17, 7 and 1 case of C1, C2 and C3 type injuries respectively. Twenty three cases underwent surgical treatment. Results: The average Majeed’s score was 66.6 points, and 15 patients (60%) had good or excellent results. The complications included 3 cases of non-union and 1 case of SI joint infection were complications. The clinical results were worse in those patients with neurological symptoms. Conclusion: Satisfactory results were obtained after surgical treatment of C type pelvic ring injuries. Neurological injuries affected the clinical outcome and appropriate fixation of the anterior ring was needed for stable fixation of C type pelvic ring injuries.

Musculoskeletal injuries associated with earthquake: A report of injuries of Iran's December 26, 2003 Bam earthquake casualties managed in tertiary referral centers

This is a descriptive analysis, performed on victims of Iran's December 26, 2003 Bam earthquake that were referred to tertiary referral trauma management centre in Tehran. Two hundred and ten patients were included in this study. Associated musculoskeletal injuries and renal function of the patients were recorded. The mean time under rubble was 1.9 h in our patients with a mean rescue to first medical aid time of 13.5 h. We had 19 cases of compartment syndrome and 6.7% of patients had impaired renal function. The incidence of compartment syndrome had a direct relation to the time under rubble and the incidence of renal failure was directly related to rescue to first medical aid time. Axial skeleton fractures, amongst them the lateral compression type pelvic fractures, were particularly common. Fracture associated neural injuries were also common. Institution of renal protective protocols from the very first hours after injury more conservative approaches to treatment of fractures in these crush trauma patients are strongly recommended.

Beckenringverletzung. Diagnostik und aktuelle Behandlungsm�glichkeiten

Pelvic fracture, especially in combination with multiple trauma, can still lead to ife-threatening situations. Only clear inclusion criteria and decisions can ensure survival of the patient, the key task being mechanical stabilization using external fixators or pelvic clamps with or without surgical intervention for hemostasis. The basis for problem-orientated management is a precise classification, which is based on conventional X-rays in emergency situations and detailed analysis of computed tomography for the planning of definitive surgical interventions. The classification groups postulated are stable pelvic fractures (type A), rotational unstable pelvic fractures (type B -- partial stability of the posterior ring present), and translational instabilities (type C -- with a complete disruption of the anterior and posterior pelvic ring). This classification leads to clear indications for pelvic ring stabilization as surgical interventions are only exceptionally indicated in type A fractures, stabilization of the anterior ring is sufficient for type B fractures, and combined posterior and anterior stabilization is necessary for treatment of type C fractures. Following these concepts and by using standardized procedures and implants, the high rate of enclosed anatomical healing can be achieved even after type C injuries. Nevertheless, the role of concomitant soft tissue injuries and scar formation is not clear as the origin of the frequently observed long-term clinical impairments even after anatomical reconstruction of the osteoligamentous structures.

Pelvic fractures management in a teaching hospital in Nigeria

BACKGROUND: Significant external forces are required to fracture a normal pelvis. The forces usually result from rapid deceleration or crushing injuries. Associated injuries are common as the energy is delivered to multiple anatomical sites. AIMS/OBJECTIVE: The aim of this study was to highlight the pattern of presentation of pelvic injuries, causes, types of the pelvic fracture and outcome of the treatment of these injuries in a teaching hospital in a developing country. SETTING: Department of Orthopaedic Surgery and Traumatology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria. DESIGN: A seven-year retrospective study was done from January 1995 to December 2001. RESULTS: The mean age of the patients at presentation was 35.0+14.8 (SD) with 42 males and 11 females. The mean injury severity score was 20.1. Motor vehicular accident remains the most common cause of pelvic fractures in 37(69.8%) patients, fall from height in 8(15.1%) patients, collapsed walls of dilapidated building in 4(7.6%) patients, motor vehicle pedestrian accident and motorbike pedestrian accidents in 2(3.8%) patients each. The type of pelvic fracture was classified according to Tile. Types A, B, and C were found in 24(45.3%), 17(32.1%), and 12(22.6%) patients respectively. In three patients, the fractures were open. Directly associated injury was diagnosed in 9 patients, these were mainly urogenital system, 2 had bladder injuries, 4 had urethral injuries and 3 had vagina laceration. All the patients were managed without recourse to open operative reduction. The outcome was adjudged excellent, good, fair and poor in 18(34%), 20(37.4%), 9(17%), and 6(11.3%) patients respectively. CONCLUSION: It was concluded that most types of pelvic fractures could be managed with satisfactory results in this environment using the facilities available. KEY WORDS: Pelvis fracture, motor vehicle accidents, falls. Nigerian Journal of Orthopaedics and Trauma Vol.3(1) 2004: 10-15

67: Does the Type of Pelvic Fracture Correlate with the Type of Lower Urinary Tract Injury?

67: Does the Type of Pelvic Fracture Correlate with the Type of Lower Urinary Tract Injury?

Computed tomography-guided screw fixation of a sacroiliac joint dislocation fracture: a case report

A 19-year-old woman sustained a vertical shear type pelvic fracture. Sacroiliac fixation using computed tomography (CT)-guided cannulated screws was performed for a left sacroiliac dislocation fracture, and a satisfactory result was obtained over time. Patients who have posterior instability of the lateral compression or vertical shear type do not obtain adequate stability by fixation of the anterior part alone; and they often have persistent residual pain, necessitating internal fixation of the posterior part later. Advantages of CT-guided sacroiliac screw fixation include precise evaluation of the degree of reduction and absence of nerve and vascular damage during the time the screw is inserted into the sacral body. This procedure is a useful, safe method owing to its minimal invasiveness in patients with unstable pelvic fractures that are reducible by manual manipulation or traction.

Pelvic trauma in rapidly fatal motor vehicle accidents.

To study the incidence and nature of pelvic fractures in rapidly fatal automobile accidents. Retrospective. County Medical Examiner's Office. The files of 255 consecutive motor vehicle accident fatalities examined at the Jefferson County Coroner/Medical Examiner's office (study period 1996-1998) were reviewed. We correlated this information with our previous findings, derived from a review of 392 such cases (study period 1994-1996). Approximately 25% of decedents involved in rapidly fatal automobile accidents sustained pelvic fractures. In 93% of the cases, postmortem radiographs were available and suitable for scoring according to the Orthopaedic Trauma Association nomenclature. The distribution of pelvic fractures by type was type A, 16%; type B, 32%; and type C, 52%, with the most common pelvic fracture being type C1 (26%). Additionally, pedestrians and motorcyclists were twice as likely to sustain a pelvic fracture, and the severity of pelvic fracture type seemed to correlate with increasing speed of the automobile. No correlation between drug use or direction of impact and incidence or type of pelvic fracture was observed. Compared with published studies on survivors of automobile accidents, our data suggest that pelvic injuries may tend to be more severe in victims who do not survive to hospitalization. Our data indicate that current estimates about the mortality of pelvic fractures may be faulty due to exclusion of victims who fail to survive to hospitalization. This series suggests that an appreciation of the full spectrum of pelvic ring disruptions requires collaboration between orthopaedic surgeons and forensic pathologists.

Beckenringverletzung

Pelvic fracture, especially in combination with multiple trauma, can still lead to life-threatening situations. Only clear inclusion criteria and decisions can ensure the survival of the patient, the key task being mechanical stabilization using external fixators or pelvic clamps with or without surgical intervention for hemostasis. The basis for problem-oriented management is a precise classification, which is based on conventional X-rays in emergency situations and detailed analysis of computed tomography for the planning of definitive surgical interventions. The classification groups postulated are stable pelvic fractures (type A), rotational unstable pelvic fractures (type B--partial stability of the posterior pelvic ring present), and translational instabilities (type C--with a complete disruption of the anterior and posterior pelvic ring). This classification leads to clear indications for pelvic ring stabilization as surgical interventions are only exceptionally indicated in type A fractures, stabilization of the anterior ring is sufficient for type B fractures, and combined posterior and anterior stabilization is necessary for treatment of type C fractures. Following these concepts and by using standardized procedures and implants, the high rate of enclosed anatomical healing can be achieved even after type C injuries. Nevertheless, the role of concomitant soft tissue injuries and scar formation is not clear as the origin of the frequently observed long-term clinical impairments even after anatomical reconstruction of the osteoligamentous structures.

Pelvic fractures in a pediatric level I trauma center.

Assess the characteristics associated with the risk of complications and mortality in children sustaining pelvic fractures. Urban university pediatric Level I trauma center in a large metropolitan community. Retrospective analysis of 57 consecutive children with 66 pelvic fractures seen between 1993 and 1999. Fifty-two patients were treated nonoperatively, and five patients required operative stabilization (four acetabular fractures and one partial sacroiliac joint disruption). Type and cause of pelvic fracture, type of management used, incidence of associated injuries, hemorrhage requiring transfusion, and mortality. Hemorrhage directly related to the pelvic fracture occurred in only one patient (2%), whereas 11 other patients required transfusions associated with other body-area injuries. Three patients with pelvic fractures died (5%), but deaths were due to other body-area injuries. Children with pediatric pelvic fractures require careful evaluation for other body-area injuries, as these are most likely to be related to hemorrhage or mortality.