Pelvic Fractures Research Articles

A Retrospective Study of Ballistic Pelvic Fractures With Focus on Short-Term Clinical Outcomes.

To evaluate the orthopaedic management, associated injuries, and outcomes in patients treated for low-velocity ballistic pelvic fractures. Retrospective chart review. Single, urban, Level I trauma center. Patients 15 years or older treated for low-velocity ballistic pelvic (OTA/AO 61 and 62) fractures from May 2018 to August 2021. Primary study measures included pelvic fracture location, concomitant associated injuries, surgical interventions, and antibiotic treatment. Postinjury sequelae evaluated include infection, neurologic deficit, and need for orthopaedic removal of foreign body. Risk factors of postinjury sequelae were investigated. A total of 156 patients with ballistic pelvic fractures were included. The cohort consisted of 135 (86.5%) male patients with a mean age of 29.8 years. One hundred ten (70.5%) patients sustained 2 or more gunshot wounds. Ninety-eight (62.8%) patients underwent an exploratory laparotomy with 79 (50.6%) having a confirmed concomitant intestinal injury. Additional associated injuries included nerve injury (13.5%), vascular injury requiring repair or embolization (10.9%), and bladder injury (10.3%). Nine (5.7%) patients underwent orthopaedic operative management-five (3.2%) patients for operative fixation and 4 (2.5%) patients for removal of intra-articular foreign bodies. Diabetes (odds ratio [OR]: 33.1, P = 0.025), neurologic deficit on presentation (OR: 525.2, P < 0.001), vascular injury requiring repair or embolization (OR: 8.7, P = 0.033), and orthopaedic pelvic fixation (OR: 163.5, P = 0.004) were positively associated with the defined postinjury sequelae at 30 and 90 days of follow-up. There was not a statistically significant association between infection and retained foreign body (OR: 3.95 [95% CI 0.3-58.7, P = 0.318]) or bowel contamination (OR: 6.91 [95% CI 0.4-58.7, P = 0.178]). Ballistic fractures of the pelvis and acetabulum rarely required operative fixation (3.2%) or irrigation and debridement. Neither retained foreign body nor presumed bowel contamination of pelvic fractures had a statistically significant association with infection, which further supports conservative management of these injuries. Patients with diabetes, neurologic deficit on presentation, vascular injury necessitating intervention, and orthopaedic fixation of pelvic fracture are associated with increased risk of postinjury sequelae. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Pelvic Binder Radiography Is Safe and Feasible for Quantifying Fracture Instability in LC1 Pelvis Fractures: A Clinical Trial.

To demonstrate fracture displacement, patient tolerance, and in-hospital safety quantifying lateral compression type 1 (LC1) pelvis fracture stability with awake stress radiography using a pelvic binder (PBR). Prospective clinical trial of PBR diagnostic intervention. Two centers, Level I trauma center and academic hospital. Alert adults with LC1 (OTA/AO B1.1/2.1) pelvic fractures from blunt mechanism presenting within 3 weeks of injury between February and December 2023 without hypotension or injury precluding pelvic binder application. The primary outcome was fracture displacement on PBR. Secondary outcomes included feasibility (≥85% patient tolerance) and safety (no major adverse events). Exploratory outcomes included pain during examination, opioid medication consumption within 96 hours, length of hospital stay, discharge destination, and correlation between fracture displacement on PBR and examination under anesthetic. One hundred sixty-nine patients with pelvis fractures were screened, 58 were eligible, and 31 were enrolled. The mean age of enrolled patients was 58.7 ± 23 years, 54.8% were female, 22.6% were White, and 67.7% Hispanic. Fracture displacement was 4.3 ± 4.7 mm on PBR at 5 kg and 8.4 ± 9.0 mm at 10 kg. All patients tolerated PBR. Sixteen patients (52%) reported pain during PBR but completed the test. No patient experienced an adverse event. Patients received 40.4 ± 56.4 mg oral morphine equivalents within 96 hours of PBR. Ten patients (32.2%) received internal fixation. The median hospital stay was 6 days (interquartile range 5.5 days) with no inpatient mortality. Fourteen patients (45.2%) discharged home. PBR is feasible and safe as a point-of-care test for LC1 pelvis fracture instability. Level II Diagnostic.

Pelvic Fracture in Multiple Trauma: Classification by Mechanism is Key to Pattern of Organ Injury, Resuscitative Requirements, and Outcome.

Pelvic Fracture in Multiple Trauma: Classification by Mechanism is Key to Pattern of Organ Injury, Resuscitative Requirements, and Outcome.

Percutaneous Titanium Elastic Nail Stabilization for Pelvic and Acetabular Fractures: Surgical Technique and Case Series.

The stabilization of fractures of the anterior pelvic ring and anterior column of the acetabulum with antegrade or retrograde intramedullary screws has been frequently described. However, these narrow and nonlinear bony corridors can be challenging and dangerous to accommodate with rigid linear implants. Titanium elastic nails (TEN) are ideal implants to navigate in the narrow, irregular medullary canal in this anatomical location. This study aims to describe this surgical technique and its preliminary results. From April 2018 to October 2023, patients who underwent acute TEN stabilization of their pelvic or acetabular fractures were identified from a review of medical records at a Level 1 trauma center. A focused review of their clinical documentation was performed to describe their demographics, injury patterns, the surgical techniques used in their treatment, and their clinical and radiographic outcomes. During the almost 6-year period, 19 patients were identified (age: 39 ± 22 years; 74% male). There were 3 acetabulum and 16 pelvic ring fractures stabilized. One of the 19 patients underwent bilateral TEN fixation of the superior pubic rami. Patients were followed-up through hospital outpatient clinics postoperatively (median follow-up 14 months, IQR: 8-24 months). No fractures were complicated by nonunion or secondary displacement of the reduction. A 14-year-old patient required hardware removal due to irritation, and a 19-month-old patient underwent planned hardware removal due to her age. No patients have undergone hip arthroplasty to date, and there were no instances of infection or neurovascular injury. These preliminary results are promising and suggest that larger scale assessment of the indications and feasibility of TEN stabilization in pelvic and acetabular surgery is warranted.

Construction of a nomogram for preoperative deep vein thrombosis in pelvic fracture patients

BackgroundIn recent years, the incidence of pelvic fractures has been on the rise, predominantly affecting the elderly population. Deep vein thrombosis may lead to poor prognosis in patients. monocyte-to-lymphocyte ratio is novel biomarkers of inflammation, and this study aims to verify their predictive effect and construct the nomogram model.MethodThis study used binary logistic regression analysis to predict the predictive effect of MLR on the occurrence of DVT in pelvic fractures patients. And use R studio to construct nomogram model.ResultThe results showed that Age (1.04 [1.01, 1.07], p = 0.006), WBC (1.44 [1.28, 1.61], p < 0.001), and MLR (2.11 [1.08, 4.13], p = 0.029) were independent predictive factors. The nomogram demonstrated good predictive performance with small errors in both the training and validation groups, and most clinical patients could benefit from them.ConclusionThe nomogram constructed based on MLR can assist clinicians in early assessment of the probability of DVT occurrence.

The Role of Screening for Venous Thromboembolism in Pelvic Trauma Patients: A Single-Centre Retrospective Study

Background: Venous thromboembolism (VTE) is a severe complication following pelvic trauma. Thromboprophylaxis has reduced the risk of VTE in the pelvic trauma population; nevertheless, the risk remains high. A substantial pulmonary embolism has emerged as the unexpected cause of death among patients presenting with ‘minor pelvic fractures’. The purpose of this study was to analyse the single-centre experience with a surveillance protocol. We hypothesised that DVT surveillance with VUS and CTPA may reduce the perioperative mortality–morbidity rate in the subpopulation of patients with pelvic or acetabular fractures. Methods: This is a retrospective analysis of patients admitted with pelvic or acetabular fractures between January 2001 and December 2021. In April 2013, a screening protocol for VTE was introduced. This protocol included venous ultrasound and CTPA for patients with chest injuries. Patients from two groups—one screened for VTE and one without screening—were compared. Results: Of the 3186 patients with pelvic and/or acetabular fractures who were admitted, 1975 were not screened for VTE and 1211 underwent screening. There were more VTE cases in the screening group (5.62% vs. 0.86%, p &lt; 0.001). Nine (0.46%) cases of sudden death occurred in the non-screening group, and all of them died with symptoms of acute PE. Since the screening was introduced, we have not encountered any deaths in the perioperative period (0.46 vs. 0, p = 0.02). Conclusions: The combined use of VUS and CTPA in chest-injured patients is a trustworthy means of screening for VTE, resulting in decreased mortality rates for those with pelvic and acetabular fractures by accurately diagnosing VTE during the perioperative phase.

Hip joint rice body bursitis combined with hip dysplasia and pelvic fracture: a case report

BackgroundRice body formation is an uncommon, nonspecific inflammatory process. Certain clinical features, such as chronic synovitis associated with rheumatoid arthritis, tuberculous arthritis, and osteoarthritis, can induce a non-specific response that may lead to the development of rice bodies. Currently, the etiological and prognostic significance of rice bodies remains unknown. Magnetic resonance imaging (MRI) is the preferred diagnostic imaging modality for evaluating rice body formation.Case presentationThe patient, a 44-year-old female, presented with bursitis of the hip joint and the presence of numerous rice bodies. This case is exceptionally rare and unusual as it involves a combination of hip dysplasia and pelvic fracture. The patient underwent a one-stage resection of the rice body, internal fixation of the acetabular fracture, and two-stage total hip arthroplasty, resulting in an immediate improvement in her symptoms. We reviewed the relevant literature and observed that the majority of rice bodies were predominantly found within the capsules of the shoulder and knee joints, while instances of hip joint rice body bursitis were relatively infrequent. To our knowledge, there have been no previous reports documenting a case of hip joint rice body bursitis in conjunction with hip dysplasia and pelvic fracture.ConclusionThis paper presents the rare case of hip joint rice body bursitis combined with hip dysplasia and pelvic fracture, and is one of the highlights.

Practice Patterns Vary Widely in the Care of Pediatric and Adolescent Pelvic and Acetabular Fractures: A CORTICES Survey.

Pediatric pelvic and acetabular fractures are rare but potentially devastating injuries and significant management variation exists across the United States. This study sought to elucidate treatment decision-making trends, involvement of adult trauma fellowship-trained surgeons in pediatric care, and pre- and postoperative transfer patterns. Pediatric orthopaedic surgeons who serve as trauma liaisons at 20 PTCs were surveyed regarding training, practice volume, and factors contributing to institutional management of pelvic and acetabular injuries. Five clinical scenarios of pelvic ring and acetabular fractures that varied by injury pattern, age, and sex were presented. Descriptive statistics were used to summarize the results. Eighteen institutions responded to the survey (90% response rate, 16 Level, 1 PTC). All surgeons were pediatric fellowship-trained (77.7% in practice >5y). The four most common factors affecting whether surgeons independently managed both pelvic ring and acetabular fractures were patient age, fracture characteristics, displacement and need for surgery. The majority reported managing <10 acetabular (72.2%) but >10 pelvic ring (77.8%) injuries per year. In the clinical scenarios, patients <10 were more likely to have treatment decisions made by a pediatric orthopaedic surgeon. Older patients were more likely to be transferred to another institution for surgery but were often transferred back to the PTC postoperatively. In all clinical scenarios other than posterior hip dislocation, a trauma fellowship-trained surgeon was more likely to be the operative surgeon, even when the patient was not transferred. There is substantial variation in the management of pediatric and adolescent pelvic and acetabular fractures. Even at tertiary care PTCs, volumes are low, and trauma fellowship-trained surgeons are often involved in decision-making and operative management. Age and injury pattern seem to play a large role in variation, and patient transfers between facilities are common. V.

Computed tomography of the equine caudal spine and pelvis. Pathological findings in 56 clinical cases (2018-2023).

Computed tomography (CT) of the axial skeleton is increasing across many equine hospitals. CT of the pelvis and caudal spine in a large group of clinical cases has not been reported previously. To describe the pathological lesions identified in the caudal spine/pelvis in horses and ponies undergoing CT spine of this region. A retrospective case series. Horses with CT imaging of the caudal spine/pelvis were included. Horses aged under 6 months and those with CT examinations performed post-mortem were excluded. Fifty-six horses met the inclusion criteria. Ages ranged from 8 months to 20 years and bodyweights from 85 to 680 kg (mean 488 kg). Horses presented predominantly for lameness (30/56) and poor performance (18/56). Osseous pathology was identified in 41/56 horses; including osteoarthritis of the sacroiliac joint(s) (n: 28), pathology of the intervertebral disc joint(s) (n: 12), pelvic fractures (n: 9), osteoarthritis of the coxofemoral joint(s) (n: 8), ventral spondylosis (n: 6), acetabular rim fracture (n: 2), dislocation of coxofemoral joint(s) (n: 2), and dorsal dermal sinus of the sacrum (n: 1). The relationship between CT imaging findings and clinical signs in horses remains unclear. Further work is required to describe the relationship between congenital, developmental, and acquired changes in the caudal spine and pelvis, and clinical signs. CT of the caudal spine and pelvis can be utilised in horses and ponies for diagnosing a range of clinical disorders that may be causing 'lumbosacroiliac pain', poor performance, hindlimb lameness, and stiffness. The pathologies we observed were diverse and many patients had multiple lesions.

Epidemiological characteristics and impact of sepsis on survival after osteoporotic pelvic fracture in Austria.

We performed a retrospective nationwide register-based cohort study which included all in-hospital patients aged ≥ 50 with pelvic fracture (PF) between 2010 and 2018 in Austria. We identified patients who were hospitalized with sepsis within 180 days following a PF event. Aetiology of sepsis was divided by unspecified, gram positive, gram negative and other. Among 59,081 patients hospitalized with PF between 2010 and 2018 we identified 619 (1.05%) patients who were hospitalized with sepsis within 180 days following PF. The cumulative incidence risk of sepsis within 180 days after PF was significantly higher in males (1.4%, 95% CI 1.2%-1.5%) as compared to females (0.92%, 95% CI 0.83%-1.0%), p < 0.001. In the cohort of patients with sepsis, the one-year mortality was 50.4%. Mortality risk was greater for patients who developed sepsis, independently of age, sex and comorbidity status (HR 3.12, 95% CI 2.83-3.44, p < 0.001) as compared to patients without sepsis. With a very high one-year mortality risk among those who develop sepsis, our study emphasizes the substantial impact of sepsis on long term survival in fractured patients. These findings underscore the critical need for sepsis prevention and early detection and management to mitigate its detrimental effects on patient outcomes.

Preoperative Imaging-Guided Surgical Planning in Complex Pelvic Fractures - Innovations in Traumatology and Radiology for Enhanced Clinical Outcomes: A Systematic Review

This systematic review will explore role of preoperative imaging-guided surgical planning for the management of complex pelvic fractures. Pelvic fractures occurs in high-energy trauma and cause challenges for intricate anatomy and have a high association with vascular, visceral injuries. Traditional imaging methods frequently fail to capture injury complexity while increasing surgical risks. Recent advancements of imaging technology CT, MRI, 3D reconstructions along with and AI-based predictive models offer enhanced precision in diagnosing and planning surgical interventions with detailed insights into fracture patterns, bone density, and soft tissue damage which enable accurate surgical planning to reduce intraoperative complications and shorten recovery times. We aim to systematically investigate effectiveness of modern imaging techniques with potencies in clinical outcomes, with an emphasis on improved surgical accuracy and patient safety. Analyzing range of studies, we have established evidence-based recommendations for integrating advanced imaging technologies into routine trauma care showing critical role these innovations play in improving both short-term recovery and long-term clinical outcomes for patients having complex pelvic fractures.

Effect of Silodosin on bladder outlet during antegrade cystourethrogram in patients with pelvic fracture urethral distraction defect

Background: Pelvic fracture urethral distraction defect is a traumatic injury to the male urethra that affects the region between the bulbar urethra and the prostatic apex. Pelvic fracture causes urethral injury in about 10% of patients. Combined retrograde urethrogram and antegrade cystourethrogram is used to define the length of the urethral injury before planning the definitive surgery. But during antegrade cystourethrogram bladder outlet sometimes fails to open due to faulty technique, prolong suprapubic catheterization and increase sympathetic drive, leading to erroneous estimation of the length of urethral injury. To overcome this problem Silodosin used in this study, which is a highly uroselective and rapid-acting α-adrenoreceptor antagonist in comparison to other α-adrenoreceptor antagonists available in the market. The uroselectivity of Silodosin helps in maximizing the effect by opening the bladder outlet and limiting the adverse effect on the cardiovascular system.The objective of the study was to assess the effectiveness of Silodosin in opening bladder outlet in patients with pelvic fracture urethral distraction defect on antegrade cystourethrogram. Methods: This is a Quasi-experimental study that was conducted in the Department of Urology, Bangabandhu Sheikh Mujib Medical University. In this study, 35 Patients with pelvic fracture urethral distraction defect with suprapubic catheter in situ who failed to open the bladder outlet on initial antegrade cystourethrogram were included. Urine culture and sensitivity report is confirmed negative. All participants were received a single dose of Silodosin capsule 3 hours before the antegrade cystourethrogram. Retrograde urethrogram was performed. After 3 hours bladder was filled with diluted contrast through the indwelling suprapubic catheter under sterile conditions according to bladder capacity. When the participants were felt the normal desire to void, bladder filling was stopped and voiding command was given and x-ray films were taken. Then the x-ray films were reviewed and findings were noted about the opening of the bladder outlet and visualization of the posterior urethra. Any complications during the procedure were observed and noted. After confirming hemodynamic stability, patients were advised to go home and continue the prescribed antibiotic for 5 days. Results: Thirty-five men were evaluated during this study period. The mean ages of the patients were 39.9±10.4 years. All patients had a suprapubic catheter in situ and the mean duration of the suprapubic catheter was 3.8 ± 1.5 months. On average 363±87.3 ml of diluted contrast were introduced to initiate voiding reflex. Thirty-two patients out of the 35 patients (91.4%) were able to achieve the satisfactory opening of the bladder outlet (95% confidence interval 82.11- 100%), while 3 patients (8.6%) failed to open the bladder outlet. No patient developed postural hypotension after single dose of Silodosin. Two patients were reported post procedure (combined retrograde urethrogram and antegrade cystourethrogram) fever, which needed another 5 days antibiotic treatment. Conclusion: Single dose of Silodosin before antegrade cystourethrogram conferred a statistically significant increase in opening the bladder outlet inpelvic fracture urethral distraction defectpatients. Bangladesh Crit Care J September 2024; 12 (2): 138-144

The Impact of Psychosomatic Disorders and Forensic Consequences in Patients with Hip Fractures

We used a cross-sectional study to investigate potential correlations between psychosomatic disorders generated by irrational beliefs and forensic involvement in patients with pelvic fractures. The study focused on 198 participants who completed the White Bear Suppression Inventory (WBSI). These results suggest that there is essentially no significant linear correlation between age and WBSI score in the 198 observation dataset. The findings from this dataset contribute to our understanding of key demographic factors, the distribution of forensic complications, age characteristics, and WBSI scores within the study population. The statistical analyses did not reveal any significant associations or correlations, suggesting a level of independence between the variables. This insight provides a valuable foundation for future medical research and deeper analysis. These results offer a reliable starting point for further exploration and investigation.

Severe multiple injuries in a 15-year-old boy with pelvic fracture complete anterior dislocation of the sacroiliac joint and rupture of the internal and external iliac arteries: A case report of a rare injury.

Anterior dislocation of the sacroiliac joint combined with pelvic fractures is relatively rare in clinical practice. It is often associated with hemodynamic instability and severe injuries to other regions, resulting in a complex condition, prolonged treatment duration, and high rates of mortality and disability. However, there are few reports in the literature describing the diagnosis and treatment of anterior dislocation of the sacroiliac joint. In this case, the patient sustained a pelvic fracture with anterior sacroiliac joint dislocation and rupture of both the internal and external iliac arteries following a motor vehicle accident, making it an even rarer and more challenging case to treat. Reporting such cases can enhance the understanding of the diagnosis and treatment of anterior sacroiliac joint dislocation with rupture of the iliac arteries and provide valuable references for similar cases. The patient was riding an electric bicycle and was hit by a small truck, resulting in a pelvic fracture, anterior dislocation of the sacroiliac joint, and rupture of the internal and external iliac arteries. The patient was diagnosed with open pelvic fracture (type C1.2), left complete anterior dislocation of the sacroiliac joint, left acetabular fracture, left internal and external iliac arteriovenous rupture. emergency room resuscitation, intensive care unit resuscitation, 6 surgeries and perioperative management. He has been discharged from the hospital for more than 1 year and was rechecked every month after discharge, the fracture has healed, there is no obvious pain and discomfort in and around the wound, he has been fitted with a prosthesis, and he is doing the walking function exercise. Pelvic fracture with anterior sacroiliac dislocation is clinically rare and critical, and is associated with large vessel rupture, severe organ damage, and high mortality and disability rates. Rapid restoration of pelvic stability and hemodynamic stability is the key to treatment. Rapid transfer to a tertiary trauma center, rapid examination through the green channel to clarify the diagnosis, close intensive care, and reasonable multidisciplinary teamwork for surgical intervention are all valuable experiences that we have concluded.

Comprehensive Management of Pelvic Trauma in Pregnant Patients

Pelvic fractures occur frequently due to traffic accidents and high-energy. Pregnant women are susceptible to trauma, with one in 12 pregnancies complicated by such incidents, making trauma the leading cause of non-obstetric maternal deaths during pregnancy. Pelvic fractures during pregnancy pose significant risks, potentially leading to adverse pregnancy outcomes such as preterm delivery, placental abruption, fetal distress, and even maternal or fetal death. The physiological changes that occur during pregnancy, including increased blood volume and altered cardiovascular dynamics, further complicate the management of pelvic trauma in pregnant patients. Prompt and appropriate management of pelvic trauma in pregnant patients is essential to optimize outcomes for both the mother and the fetus. Initial evaluation and stabilization of the mother take precedence, with close attention to airway, breathing, and circulation. Diagnostic imaging, including pelvic X-rays and, when feasible, body CT or MRI, aids in assessing the extent of pelvic injury and identifying associated injuries. Definitive treatment of pelvic fractures may involve a combination of surgical fixation, bed rest, traction, and pelvic slings, depending on the severity of the injury. The timing and approach to delivery in pregnant patients with pelvic fractures require careful consideration, with vaginal delivery being a viable option in many cases, provided that the pelvic architecture remains intact. Conclussions: The management of pelvic trauma in pregnant patients requires a multidisciplinary approach and careful consideration of maternal and fetal well-being. Further research is needed to establish clear treatment guidelines and preventive strategies to reduce the incidence of pelvic fractures during pregnancy and improve outcomes for both mother and fetus.

Efficacy of EFAST-PS in pelvic trauma for the assessment of the pubic symphysis in emergency settings: a mini review

The EFAST technique is a rapid ultrasound method introduced into ATLS guidelines since 2006 for the evaluation of trauma patients. It allows for the detection of free fluid in the abdomen, pericardial tamponade, and pneumothorax within 2 to 3 minutes without impacting management times in pre-hospital settings. Recently, the EFAST-PS protocol has been introduced, which includes an additional scan of the pubic symphysis to identify “open book” pelvic fractures. This mini review examines the efficacy of the EFAST-PS protocol in pre-hospital environments through a literature review and analysis of a clinical case. It is demonstrated that EFAST has high specificity and sensitivity in detecting free fluid in abdominal and thoracic recesses, improving the management of trauma patients and reducing time to definitive intervention. The addition of the pubic symphysis scan did not cause any issues but increased safety in managing patients with suspected fractures and hemodynamic instability. Emergency ultrasound assessment, including the EFAST-PS protocol, should be integrated into the overall clinical picture to provide useful data for the decision-making process.

Scrotal Hematoma Following Pelvic Fracture

Scrotal Hematoma Following Pelvic Fracture

CT-Based Evaluation of Volumetric Posterior Pelvic Bone Density with Implications for the Percutaneous Screw Fixation of the Sacroiliac Joint.

Background: Operative treatment of fragility fractures of the pelvis has become a gold standard. Preoperative planning, including the assessment of the pathway for iliosacral screws, is crucial. The anchorage of the screw depends on the bone quality. Some recent studies have concentrated on assessing bone mineral density (BMD) with the use of Hounsfield unit (HU) values obtained from CT scans. The aim of the present study is to determine the best sacral levels of S1-S3 on the pathway of iliosacral screws for sacroiliac joint fixation. Methods: Patients admitted to the Independent Public Healthcare Center in Rypin between 1 of September and 1 of December in 2023, who had CT scans of the pelvis performed on them for different reasons, were included in this study. In total, 103 patients-56 men and 47 women-were enrolled in the study and consecutively separated into two groups of different ages: 18-60 years old (group A) and above 60 years old (group B). The volumetric bone density expressed in HU values was measured with sacral levels of S1, S2 and S3. Apart from the bodies of sacral vertebrae S1-S3, our measurements involved the ala of the ilium in the vicinity of the sacroiliac joint and the wing of the sacrum. All the measurements were performed on the pathway of presumptive iliosacral screws to stabilize the sacroiliac joint. Results: In group A (58 patients) the highest bone density in sacral bodies was found in S1 that gradually decreased to S3, while the opposite tendency was demonstrated in the ala of ilium. The HU values in the wing of the sacrum did not display statistical significance. In group B (45 patients), the highest bone density was also found in the sacral body S1 that decreased toward S3 but in the ala of ilium, the highest bone density was found with level S1 and lowest with level S2. In both groups, the highest bone density referred to the wing of the sacrum. Conclusion: While the perfect construct for posterior pelvic ring fixation remains unclear, our findings may imply that sacroiliac joint screws inserted into the wing of the sacrum of greater bone density could provide much more successful fixation in comparison to those anchored in the body of sacral vertebra of lesser bone density.

Comparison of the AO/OTA 1996/2007 and 2018 pelvic ring fracture classifications.

Pelvic ring fractures may present with relevant mechanical and haemodynamic instability. Classifications of the bony or ligamentous injuries of the pelvic ring are well established. The most common classifications used analyse the injury mechanisms and the resulting instability of the pelvic ring structure. Fracture classifications should be simple and easy to use, comprehensive, andradiographically and anatomically based, resulting in a hierarchical alphanumeric order of types and subtypes and thereby allow adequate treatment decisions based on a high degree of inter- and intraobserver reliability. In 2018 a new AO/OTA pelvic ring fracture and dislocationclassification was published that combined the most commonly used "historical" classification schemes, e.g. the Tile/AO classification and the classification according to Young and Burgess. Compared with these older classifications, several relevant changes were integrated in the 2018 edition. The changes between the AO/OTA 1996/2007 and 2018 classifications were analysed in detail. Overall, several problems were identified regarding the type-B pelvic ring injury classification. These changes may result in difficulties in classifying pelvic ring injuries and thereby prevent relevant comparisons between former and future clinical studies on pelvic injuries.Level of Evidence: V.

Use of a newly developed minimally invasive bilateral fixed angle locking system in the treatment of pathological pelvic fractures: a case series

BackgroundMetastatic bone disease (MBD) and its complications have a significant impact on patients’ quality of life. Pathological fractures are a particular problem as they affect patient mobility and pose a high risk of non-union. The pelvis is frequently affected by MBD and its fixation is challenging. We present a case series of three pathological sacral fractures treated with a new minimally invasive bilateral fixed angle locking system.Case presentationCase 1 and 2 suffered a pathological transforaminal sacral fracture without adequate trauma in stage 4 carcinomas (gastric cancer and breast cancer). Both were initially treated with non-surgical treatment, which had only a limited effect and led to imminent immobility. Both were operated on with fluoroscopic navigation and underwent transsacral SACRONAIL® stabilisation according to CT morphology (S1 + S2 and S1 respectively). Immediately after the operation, pain decreased and mobilisation improved. Case 3 had a pathological transalar sacral fracture during the 2nd cycle of chemotherapy due to non-Hodgkin’s lymphoma. He soon became immobile and could only move in a wheelchair. The operation was performed with CT navigation due to the very small corridors and an implant was inserted in S1 and S2. The patient reported immediate pain relief and his ability to walk improved over the following months. Despite continued chemotherapy, no wound complications occurred.ConclusionsThe cases show the advantages of the minimally invasive bilateral fixed angle locking system SACRONAIL® in the treatment of patients with pathological sacral fractures. It allows immediate full weight bearing and the risk of secondary surgical complications is low. All cases showed an improvement in pain scores and mobility.