Sacral Fractures After Short-Course Radiation Therapy for Rectal Cancer.

Healing remains a clinical challenge in nonoperatively treated fragility fractures of the pelvis (FFPs). Modifying gut microbiota has been found to affect cytokine pathways involved in bone formation and resorption. This study examined the impact of probiotic treatment pre- and postunilateral pubic rami fracture on bone microstructure and load-to-failure of healing fractured and intact (unfractured) contralateral hemipelvises. Twenty-one 6-month-old female Sprague Dawley rats were bilaterally ovariectomized and housed for 3 months to establish an osteoporotic phenotype. At 9 months old, stable unilateral fractures of the superior and inferior pubic rami of the left hemipelvis (type 1a FFP) were created. Before fracture creation, rats were randomly separated into control (phosphate-buffered saline administered for 12 weeks), prefracture treatment (probiotics administered for 12 weeks starting 6 weeks prefracture), and postfracture treatment (probiotics administered for 6 weeks postfracture) groups. At 6 weeks postfracture, rats were sacrificed, and their pelvises were harvested, microcomputed tomography imaged, and evaluated through microstructural analysis and biomechanical testing. On the intact hemipelvises, the prefracture treatment group (n = 5) had significantly higher bone volume (BV) ( P = 0.050), bone volume fraction (BV/TV) ( P = 0.019), bone mineral density ( P = 0.019), and tissue mineral density (TMD) ( P = 0.014) than those in the postfracture treatment group (n = 7). The intact hemipelvises of the prefracture treatment group also had significantly increased trabecular thickness (TbTh) ( P = 0.021) when compared with those in the control group (n = 6). On the fractured hemipelvises, the prefracture group had increased total volume (TV) ( P = 0.020), BV ( P = 0.011), and BV/TV ( P = 0.026) when compared with the control group (n = 4). Although load-to-failure was correlated with microstructural parameters (BV/TV (r = 0.42, P = 0.015), trabecular number (TbN) (r = 0.42, P = 0.014), bone mineral density (r = 0.55, P = 0.0008), TMD (r = 0.40, P = 0.019), and trabecular spacing (TbS) (r = -0.58, P = 0.0003), no significant differences in bone strength were found between groups. Probiotic treatment was shown to improve bone microstructure in osteoporotic rats; however, efficacy was related to treatment timing and duration. Administration of probiotics for 12 weeks beginning 6 weeks prefracture significantly enhanced bone quality in both the healing fractured and intact contralateral hemipelvises. This suggests a critical timing threshold exists for probiotic therapy to impact the gut microbiome, facilitating an alteration of the immune response postfracture and producing positive structural changes in osteoporotic pelvic bone.

To compare deep infection rates from ballistic ilium fractures in which the trajectory traversed the bowel before entering bone versus those that enter the bone before bowel, and to identify factors associated with deep infection of the bony pelvis. Retrospective cohort study. Eight Level I trauma centers. Patients 18 years or older with ballistic ilium fractures (OTA/AO 61) and minimum 6 months of radiographic and clinical follow-up from January 2019 to December 2024. The primary study outcome was the rate of secondary deep pelvic bony infection requiring subsequent surgical irrigation and debridement. Associations between ballistic trajectory (traversing bowel before entering bone [Bowel] vs. bone before entering the abdomen [Bone]) were determined from computed tomography images; concomitant associated injuries, patient characteristics, and other interventions with the primary outcome were assessed using multivariable logistic regression. A total of 201 patients with ballistic ilium fractures were included; 88.6% were men, and the average age was 32.9 ± 12.3 years. Of these, 83 (41%) sustained ballistic injuries that traversed the bowel before entering bone (Bowel), 69 (34%) entered the bone before the bowel (Bone), and 49 (24%) had an indeterminate trajectory. The Bowel cohort had a higher average injury severity score (20.2 vs. 12.5, P < 0.001), lower prevalence of other drug use (39.8% vs. 56.5%, P = 0.025), and greater incidence of exploratory laparotomy (90.4% vs. 36.2%, P < 0.001). Patients with bowel experienced higher rates of deep infection requiring surgical debridement (10.8% vs. 1.4%, P = 0.017). On multivariate analysis, deep infection requiring surgical bony debridement was significantly associated with bullet trajectory traversing the bowel before entering the bone (odds ratio: 14.6; 95% confidence interval: 1.3-160.8, P = 0.021). Ballistic ilium fractures that traverse the bowel before entering bone were associated with higher rates of deep infection requiring bony debridement. The role of acute bony irrigation and debridement in these patients warrants further investigation. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

ObjectivesPelvic fractures are common in feline trauma patients and often involve multiple structures due to the rigid anatomy of the pelvis. This study aimed to investigate the radiographic distribution of pelvic lesions in cats, to identify potential correlations among specific pelvic lesions, and to evaluate the relationship between lesion type and total number of lesions.MethodsA retrospective bicentric study was conducted on cats presenting with pelvic trauma, based on orthogonal pelvic radiographs. Pelvic lesions were classified anatomically and statistical analysis were performed to evaluate associations among different lesions types and between lesion type and total number of lesions.ResultsEighty cats with pelvic trauma were included. A total of 267 pelvic lesions were identified, with a mean of 3 lesions per patient, and most cats (91.2%) had multiple pelvic lesions. Sacroiliac luxation was the most common lesion. Positive statistically significant associations were identified between: 1) left and right sacroiliac luxation (ρ = 0.20, P = 0.036), 2) sacroiliac luxation with contralateral iliac fracture (ρ = 0.21, P = 0.030; ρ = 0.24, P = 0.017), and 3) pubic fractures with ipsilateral ischial fractures (ρ = 0.53, P < 0.001; ρ = 0.37, P < 0.001). Unilateral sacroiliac luxation, pubic, ischial, and pelvic symphyseal fractures were never observed in isolation, whereas coxofemoral luxation often occurred as a solitary lesion.Conclusions and relevanceFeline pelvic trauma frequently results in complex, multi-site lesions patterns and consistent associations among specific lesions suggest predictable biomechanical behaviour within the pelvic ring. Recognition of these patterns may assist clinicians in the systematic radiographic evaluation of feline pelvic trauma and facilitate detection of additional, potentially occult lesions.

Stress radiographs are widely used to define instability in lateral-compression type I injuries, but its applicability to fragility fractures of the pelvis (FFP) is unclear. We investigated whether lateral stress radiographs (LSRs) predict failure of non-operative treatment in patients with FFP types I and II. In this prospective observational study, 55 ambulatory patients aged ≥ 60 years with pubic ramus fractures underwent anteroposterior (AP) and inlet LSRs. Displacement was measured on AP LSRs using the femoral head (DFH) and teardrop (DTD), and cortical apposition at the superior pubic ramus fracture was assessed on inlet LSRs. Failure of non-operative treatment was defined as inability to ambulate due to persistent or worsening pain at any time during the first week after injury. Receiver operating characteristic analysis evaluated the predictive performance of LSR-derived parameters. Of the 55 patients, seven were classified as FFP type I and 48 as type II. Non-operative treatment failed in 21 patients (38.2%), all with type II fractures. Failure was associated with DFH ≥10mm, DTD ≥10mm, and a non-appositional displacement pattern on LSRs (all p < 0.001). The displacement pattern on inlet LSRs provided the highest predictive accuracy (area under the curve [AUC] 0.96), followed by DFH ≥10mm (AUC 0.81) and DTD ≥ 10mm (AUC 0.76). LSRs may help identify instability and predict failure of non-operative treatment in patients with FFP, particularly in those with FFP type II. Assessment of the displacement pattern on inlet LSRs-specifically the presence or absence of cortical apposition under stress-showed the greatest predictive value and may serve as a practical and intuitive indicator to guide early treatment decisions.

Correction: Clinically relevant bleeding risk in low-energy fragility fractures of the pelvis in elderly patients

Background/Objectives: Uroflowmetry is done in the surveillance period after End-to-end Anastomotic Urethroplasty for pelvic fracture urethral injury. But is maximum flow rate a reliable surrogate for urethral calibre in these cases? The above question laid the foundation of the study. The aim of the study was: “Is uroflowmetry alone sufficient to predict a successful outcome following urethroplasty after pelvic fracture urethral injury (PFUI)?” Methods: We conducted a prospective masked study of all patients undergoing end-to-end anastomosis (EEA) urethroplasty for PFUI from January 2017 to September 2022. The first follow-up was 4 weeks after surgery, micturating cystourethrogram (MCU) was done after urethral catheter removal and at the same time, uroflowmetry was also done. The second follow-up was 6 months after surgery, when uroflowmetry was repeated, and urethroscopy was performed. The urologist performing urethroscopy was blinded to the uroflowmetry results. Results: In total, 26 patients were included in the study. After 6 months, 1 patient had poor flow (maximum flow rate [Q max] &lt; 10 mL/s), 7 patients had flow with Q max 10–15 mL/s, and 18 patients had normal flow (Q max &gt; 15 mL/s). On urethroscopy, all patients had a normal and easily passable urethra. The International Prostate Symptom Score (IPSS) and quality of life (QoL) scores showed a positive correlation. The urologist performing urethroscopy and the investigator recording uroflowmetry reached different conclusions. Conclusions: A reduced peak on uroflowmetry after EEA urethroplasty in PFUI does not always indicate surgical failure. Urethroscopy enables direct visualisation of the anastomotic site and provides more detailed information than uroflowmetry. The IPSS score and quality of life are more important than Q max alone.

ABSTRACT Introduction: Erectile dysfunction (ED) is a common and multifactorial complication after pelvic fracture urethral injury (PFUI), yet objective characterization of ED severity and penile Doppler findings remains limited. We aimed to describe ED severity categories and penile Doppler findings in men with PFUI undergoing anastomotic urethroplasty. Methods: We performed a retrospective analysis of a prospectively maintained database. Among 110 men who underwent anastomotic urethroplasty for PFUI between September 2022 and September 2023, 97 with complete preoperative penile Doppler ultrasound and standardized Sexual Health Inventory for Men assessment were included. Pelvic fractures were classified using the Young–Burgess system. All patients received tadalafil 5 mg daily for 6 months. Postoperative Doppler was not performed. Results: The median age was 29.5 years with a median follow-up of 11 months. Urethroplasty success rate was 85%(83/97). Preoperatively, 56 out of 97 patients had ED (42 mild/moderate; 14 severe). Penile Doppler abnormalities were nearly universal: 93 had cavernosal, and 83 had dorsal artery insufficiency. Postoperatively, 13 out of 41 men developed de novo ED, while 13 out of 56 improved by at least one severity category. Among 76 patients with complete fracture data, greater fracture severity was associated with worse postoperative ED, and worsening erectile function was more frequent among patients with urethroplasty failure. Conclusions: ED and penile Doppler abnormalities are highly prevalent after PFUI. ED severity correlated with pelvic injury severity, supporting the concept that ED reflects global trauma burden rather than isolated vascular pathology. Given the retrospective design and routine postoperative use of PDE5 inhibitors, these findings should be considered descriptive and hypothesis-generating.

In recent years, there has been a proliferation of literature describing new technologies increasingly integrated into the surgical management of pelvic fractures. However, the available data are heterogeneous, scattered, and sometimes limited to small series or single-center studies. This review aims to present new technologies in the field of pelvic and acetabular fractures and explore their potential benefits for surgeons and patients. The goal is to describe current concepts, advantages, and limitations and to open a discussion about future use and development. The search was conducted through Medline, Central and Embase databases from inception to January 2025 following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. A total of 841 records were reviewed and 115 studies were included according to the inclusion and exclusion criteria. Technologies such as robotics, navigation, patient-specific management, and 3D printing are being developed for the management of pelvic injuries. These technologies demonstrate greater surgical accuracy without increasing complications. In pelvic and acetabular fractures surgery, new technologies are very attractive and are a promising help for management of these complex injuries and need to be improved before being included in routine care.

Post pelvic binder radiograph can identify bladder injury associated with pelvic trauma: A multi-centre observational study.

Urological injury is a well-recognised complication of high energy pelvic trauma. Clinical presentation varies and should thus be considered in all pelvic fracture presentations. Careful management under the care of a service equipped to manage trauma associated urological injuries offers the best clinical outcomes for patients. A retrospective review of all significant urological injuries in major pelvic trauma presentations to a newly designated national major trauma centre in the Republic of Ireland. Eight cases were identified for inclusion in the series. Clinical course, treatment options and functional outcome varied depending on the nature and degree of injury. Four cases required definitive surgical intervention. Pelvic trauma is a significant risk factor for urological injury. In high energy events with signs of urological injury, a high index of suspicion should always be adopted. These injuries may require the expertise of a limited subspeciality service placing significant demand on day to day service provision. Adequate resource provision and service support is essential to optimise patient care.

CORR Insights®: What Is the Effect of Robot Reduction in Displaced Pelvic Fractures? A Multicenter Randomized Clinical Trial.

In the past, pelvic ring fractures were rare injuries that were classically caused by high-energy trauma. However, due to demographic change, most pelvic ring fractures today arise on the basis of osteoporosis, usually due to low-energy accidents or without an accident at all. The incidence of pelvic ring fractures has increased significantly in recent decades. Today, predominantly elderly patients are affected. Osteoporosis-related pelvic ring fractures represent a separate entity amongst fractures of the pelvis. Their treatment differs significantly from high-energy pelvic fractures, especially regarding the indication for surgical intervention and the necessary medical infrastructure. The present work provides an overview of the specifics of diagnostics, classification and treatment of osteoporosis-related pelvic ring fractures.

Sacral Insufficiency Fractures (SIFs) are a common yet frequently misdiagnosed late complication following pelvic radiotherapy for cervical cancer. Accurate differentiation from bone metastases is crucial to avoid unnecessary interventions. While MRI is sensitive for early marrow edema, integrated 18F-FDG PET/CT offers a unique simultaneous assessment of bone metabolism and systemic tumor status. However, comprehensive studies detailing the qualitative and quantitative PET/CT characteristics of post-radiotherapy SIFs are lacking. This study aims to systematically define these features and establish their discriminative value. In this retrospective study, we analyzed 32 cervical cancer patients who developed SIFs following pelvic radiotherapy and underwent 18F-FDG PET/CT imaging between January 2018 and January 2024. Diagnosis was based on characteristic radiologic findings, clinical correlation, and a minimum 12-month follow-up. Qualitative (fracture patterns, FDG uptake morphology) and quantitative (SUVmax, SUR-BP ratio, CT densitometry) parameters on 18F-FDG PET/CT were evaluated. SIFs predominantly occurred in postmenopausal women (93.7%, 30/32) at a median of 14 months post-radiotherapy. Sacral involvement was observed as follows: unilateral ala (53.1%, 17/32), bilateral alae (37.5%, 12/32), and extension to the sacral body (9.4%, 3/32). The affected segments were primarily located at S1-S3. Concomitant pelvic fractures were also frequently identified, including pubic (28.1%, 9/32), iliac (25%, 8/32), and bilateral L5 transverse process fractures (6.2%, 2/32). Common CT findings included ill-defined osteosclerosis near the sacroiliac joint (87.5%, 28/32) and linear or curvilinear hypoattenuating fracture lines (68.7%, 22/32). PET revealed characteristic mild, diffuse/patchy FDG uptake parallel to the sacroiliac joint (96.8%, 31/32) with low metabolic activity (mean SUVmax 2.45±0.74, mean SUR-BP 1.46±0.38). Quantitative CT confirmed significant osteopenia within the radiation field (mean HU 36.8±28.6 vs. 78.0±37.3 outside, p<0.001). Post-radiation SIFs predominantly affect postmenopausal cervical cancer patients due to radiotherapy-induced osteoporosis and bone vulnerability. These fractures often present with nonspecific pain and require differentiation from bone metastases, for which 18F-FDG PET/CT is essential due to its ability to detect characteristic metabolic patterns and associated osteoporotic changes. Key diagnostic features include linear or curvilinear hypoattenuating fracture lines, mild diffuse/patchy FDG uptake parallel to the sacroiliac joint, and background osteoporotic changes within radiation fields. Integrated PET/CT outperformed single-modality imaging by enabling simultaneous assessment of bone metabolism and systemic tumor status, a critical advantage over MRI (superior for marrow edema but unable to evaluate systemic disease) and standalone CT (lacking metabolic discrimination of benign vs malignant lesions). Early recognition of SIFs through integrated imaging is critical to avoid misdiagnosis and unnecessary invasive procedures, thereby guiding appropriate conservative management. SIFs represent a prevalent post-radiotherapy complication in cervical cancer patients, with a particular predilection for postmenopausal women. 18F-FDG PET/CT demonstrates high diagnostic reliability for diagnosing SIFs, which typically present as linear fractures parallel to the sacroiliac joints on a background of osteoporotic changes, accompanied by mild diffuse or patchy FDG uptake and frequently co-occurring with pelvic fractures at other sites. Integrated PET/CT is crucial for early recognition, preventing misdiagnosis as metastasis, and guiding appropriate conservative management.

Hemodynamically unstable patients with pelvic fractures have a high mortality rate. Most bleeding from pelvic fractures originates from venous and bony sources; therefore, direct compression of the pelvic wall can be effective, and preperitoneal pelvic packing (PPP) should be considered as a first-line intervention. PPP can be performed in both the emergency department (ED) and the operating room (OR). However, outcomes according to the location of PPP have not been clearly established. This study evaluated the outcomes of ED-PPP and OR-PPP based on the location where the surgery was performed. This single-center, retrospective, observational study included patients who underwent PPP for pelvic fractures with an Abbreviated Injury Scale score of ≥ 4 from July 2015 to June 2025. Data were collected from a prospectively maintained trauma registry. Patients were categorized into ED-PPP and OR-PPP groups according to the site of PPP. Baseline characteristics, injury severity (Injury Severity Score, Revised Trauma Score, and Trauma and Injury Severity Score), and interventions, including ED thoracotomy, resuscitative endovascular balloon occlusion of the aorta, tranexamic acid administration, and time to PPP and transfusion, were compared. Mortality outcome measures were evaluated at 24h, 7 days, and as overall in-hospital mortality and were risk-adjusted using W- and Z-statistic. Fifty patients were included, with 17 and 33 in the ED-PPP and OR-PPP groups, respectively. Patients in the ED-PPP group were more critically ill at presentation, with lower systolic blood pressure, lower Glasgow Coma Scale scores, and a higher incidence of cardiac arrest before PPP. Time from scene to PPP (114.4 ± 68.6 vs. 284.3 ± 186.9min) and to transfusion (84.5 ± 53.3 vs. 126.3 ± 72.5min) was shorter in the ED-PPP group. The W-statistic demonstrated a greater number of actual survivors than expected in the ED-PPP and OR-PPP groups at 24h (38.31 vs. 29.69) and 7 days (26.55 vs. 17.57), despite the high crude mortality rates (76.5% vs. 27.3%). Risk-adjusted in-hospital mortality showed no significant difference (W-statistic 3.02 vs. 5.45). PPP is associated with improved early and intermediate survival. ED-PPP significantly reduces the time to hemorrhagic control and should be strongly considered as an important rescue damage control intervention for patients with life-threatening pelvic bleeding.

Occult pelvic fractures following primary total hip arthroplasty: A retrospective CT-Based cohort study.

Impact of Repeat Catheterization on the Risk of Catheter-associated Urinary Tract Infection in Pelvic Fracture Patients.

A systematic search of PubMed and EMBASE was conducted using terms such as "pelvic insufficiency fractures", "radiotherapy" and "gynecological cancers". Citations of relevant studies were also screened. Eligible studies included gynecolgical patients treated with pelvic RT, and reporting risk factors for RRIFs. Key data, including study characteristics, incidence rates, fracture definitions, imaging and dosimetry methods and statistical approaches were extracted. The Transparent Reporting of a multivariable prediction modelfor Individual Prognosis Or Diagnosis (TRIPOD) checklist was used to assess the methodological quality of the included studies. 28 studies met the inclusion criteria. RRIF incidence ranged from 1.7% to 37.4%. Commonly reported risk factors included advanced age, postmenopausal status, higher RT doses, low body weight, pre-existing osteoporosis, and concurrent chemotherapy. Imaging protocols, fracture definitions, and timing of detection varied widely. Statistical limitations, including reliance on univariable analyses, small sample sizes, and inconsistent baseline assessments, were common and limit reliable interpretation of risk factors. Anatomical targets for dose evaluation varied, with few studies correcting for biologically effective dose. Only one study developed a predictive model for RRIFs, which demonstrated moderate performance but lacked validation. Bone health assessments were inconsistently performed. Interdisciplinary approaches to improve fracture risk prediction, reduce treatment-related toxicity, and guide clinical decision-making.

Open fractures account for approximately 2.6% of all fractures but continue to pose a significant clinical challenge due to their associated complications and potential impact on limb function. Among these complications, infection remains particularly prevalent. Although numerous recent studies have addressed this issue, many are limited by restrictive inclusion criteria, especially regarding the anatomical segments of the limbs evaluated HYPOTHESIS: We hypothesized that recent advances in open fracture management may have impacted infection rates across the entire appendicular and pelvic skeleton, and may have altered the associated risk factors compared to historical data. We conducted a retrospective, single-center, observational study including 368 open fractures treated at our institution between January 2017 and December 2020, with a minimum follow-up of one year. The primary outcome was the incidence of secondary infection. Secondary outcomes included the occurrence of other complications, the need for surgical reinterventions, and the time required for bone and soft tissue healing. A secondary infection occurred in 13.3% of cases. The most frequently isolated pathogens were Staphylococcus spp. and Enterobacter cloacae. Identified risk factors included bone loss, crush injuries, and pelvic trauma. The presence of secondary infection was significantly associated with a higher number of reinterventions, increased complication rates, and prolonged skin healing time (p < 0.05). The 13.3% secondary infection rate observed aligns with existing literature but exceeds recent reports limited to tibial fractures. Our broader anatomical scope revealed higher infection risks in ankle and pelvic fractures. Known risk factors (diabetes, high Gustilo grade, crush injuries) were confirmed, while emerging associations (high BMI, bone loss, pelvic/ankle location) warrant prospective validation. A surprising correlation between prolonged prophylaxis and infection likely reflects confounding by indication. The underuse of SFAR-recommended regimens-despite frequent isolation of amoxicillin-clavulanate-resistant Enterobacter-underscores the need to reassess prophylactic strategies. Study limitations include retrospective design and potential selection bias, but robust follow-up and comprehensive data support the clinical relevance of our findings. IV; retrospective study.

Titanium alloy implants are widely used in fracture fixation due to their excellent mechanical stability, but they often require secondary surgeries for removal. In contrast, biodegradable implants eliminate the need for removal, yet concerns regarding their mechanical strength in load-bearing bones remain. This study evaluates the clinical trade-off between mechanical rigidity and the burden of secondary surgery by comparing titanium versus biodegradable implants in limb and pelvic fractures. A retrospective cohort study was conducted on 73 patients treated between November 2021 and August 2024. Patients were divided into the titanium group (n = 40, primarily diaphyseal fractures) and the biodegradable group (n = 33, primarily metaphyseal/peri-articular fractures). Outcomes including implant palpability and reoperation rates were assessed. A stratified analysis compared outcomes in weight-bearing versus non-weight-bearing fractures. The mean age of patients was 42.6 ± 16.03 years. Titanium implants were associated with significantly higher rates of plate palpability (18/40, 45.0% vs 3/33, 9.1%; OR 8.18, 95% CI 2.14-31.3; P = 0.001) and secondary surgery (14/40, 35.0% vs 3/33, 9.1%; OR 5.38, 95% CI 1.39-20.8; P = 0.012) compared to biodegradable implants. Elective removal due to discomfort occurred in 17.5% (7/40) of titanium patients but was eliminated (0%) in the biodegradable group (P = 0.014). In the weight-bearing subgroup, biodegradable implants significantly reduced palpability (11.1% vs 53.3%, OR 9.14) without increasing complication-driven reoperations. However, three cases (9.1%) of refracture occurred in the biodegradable group compared to zero in the titanium group (P = 0.088). In this cohort, biodegradable implants were associated with a reduction in implant palpability and elective removal surgery for metaphyseal and peri-articular fractures. However, due to lower mechanical strength, titanium remains the preferred choice for diaphyseal fractures requiring high mechanical stability. These findings are limited by the retrospective design and heterogeneity of fracture sites.