Pelvic Fracture In Patients Research Articles

Traumatic extraperitoneal bladder rupture in the absence of pelvic fracture in a patient with pelvic organ prolapse: A case report and review of the literature.

Introduction and importanceTraumatic bladder rupture is a rare occurrence. It is more likely to occur following blunt injury and is associated with pelvic fractures in patients presenting with hematuria. We present a unique case of an extraperitoneal bladder rupture in a female after sustaining a minor fall in the absence of a pelvic fracture.Presentation of caseThe patient is a morbidly obese female with a history of vaginal vault prolapse who reported profuse vaginal bleeding and lower abdominal and suprapubic pain shortly after falling off of her bed. The patient showed no signs of hemodynamic instability and genital bleeding was ruled out in the emergency department. A Computed Tomography (CT) cystogram confirmed bladder rupture confined to the extraperitoneal space without any evidence of pelvic fractures.DiscussionBlunt traumatic extraperitoneal bladder rupture is typically associated with concomitant pelvic fracture. These injuries tend to occur as a result of high-impact motor vehicle or motorcycle collisions and are associated with an increased morbidity and mortality.ConclusionDedicated bladder imaging should be considered in blunt abdominopelvic trauma patients presenting with hematuria in the absence of pelvic fracture when the patient's underlying medical conditions or comorbidities increase the risk of bladder rupture. Our patient's history of pelvic organ prolapse placed her at an increased risk of traumatic injury to the bladder.

Study of Clinical Features of Pelvic Fracture in Patients with L4 and/or L5 Tranverse Processes Fracture

Study of Clinical Features of Pelvic Fracture in Patients with L4 and/or L5 Tranverse Processes Fracture

Mortality and comorbidity after non-operatively managed, low-energy pelvic fracture in patients over age 70: a comparison with an age-matched femoral neck fracture cohort and general population

BackgroundResearch on mortality and comorbidity associated with pelvic fractures in older patients is scarce. We aimed to determine the short- and long-term mortality rates of older patients with a pelvic ring fracture compared with both an age-matched cohort of patients with a femoral neck fracture and a general population, and to investigate 30- and 60-day readmission rates after pelvic fracture.MethodsThis was a retrospective cohort study done in an emergency department of a level II/III trauma center. All patients aged over 70 years diagnosed with a pelvic or acetabular fracture between January 2010 and December 2016 in our ED were identified. Two reference populations were used: patients operated due to femoral neck fracture in our institution between 2007 and 2008 and a general population aged 70 years or more.ResultsTwo hundred nineteen patients were identified. 30- and 90-day mortality was 7.3 and 11.4%, respectively. Compared to the general population, a pelvic fracture was associated with an 8.5-fold (95% CI: 5.2–13.9) and 11.0-fold (95% CI: 5.4–22.3) 90-day mortality risk in females and males, respectively. We could not observe a difference in the risk of 90-day mortality between femoral neck fracture patients and patients with a pelvic fracture. Within 30 days, 28 (12.8%) pelvic fracture patients were readmitted for in-patient care in our hospital.ConclusionsThe mortality of older patients with pelvic ring fractures resembles that after hip fracture. Although older patients with a pelvic ring fracture rarely require operative treatment, the severity of the injury should not be considered as a class apart from hip fracture.

Mortality After High-Energy Pelvic Fractures in Patients of Age 65 Years or Older.

To document in-hospital and 1-year mortality rates after high-energy pelvic fracture in patients 65 years of age or older as compared to a younger cohort. Retrospective review. Urban Level 1 academic trauma center. Seventy consecutive patients 65 years of age and older treated for pelvic fracture resulting from high-energy mechanism from 2008 to 2011. A total of 140 patients 18-64 years of age were matched to the study population based on mechanism of injury and OTA Code 61 subtype for comparison. Review of demographics, injury characteristics, hospital management, and mortality. Mortality. The overall inpatient mortality rate was 10%. The older cohort exhibited an inpatient mortality rate 3 times higher than the younger cohort (18.6% vs. 5.7%, P = 0.003). There was no difference in mortality 1 year post discharge (5.3% vs. 3.8%, P = 0.699). No significant differences in initial Glasgow Coma Scale or Injury Severity Score were identified (GCS 12.9 vs. 12.4, P = 0.363; ISS 24.7 vs. 23.4, P = 0.479). Multivariate analysis identified the Charlson Comorbidity Index (CCI) (P = 0.012) and Abbreviated Injury Scale (AIS)-chest (P = 0.005) as independent predictors of in-hospital mortality, and CCI (0.005) and AIS-abdomen (0.012) for 1-year mortality. After controlling for mechanism of injury and pelvic fracture classification, we found that adults ≥65 and those with multiple comorbidities were more likely to die in the hospital than younger adults. However, mortality within 1-year postdischarge was low and did not differ between groups. This is in sharp contrast to the high rates of postdischarge mortality observed in elderly patients with a hip fracture. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Determination of Clinical Signs and Symptoms Predicting No Pelvic Fracture in Patients with Multiple Trauma.

Background:Pelvic fracture (PF) is the second-most prevalent cause of mortality after brain trauma among multiple trauma patients. Our aim was to examine the reliability of suggestive criteria for having no PF (NPF) according to the common reported clinical signs and symptoms (CSSs).Materials and Methods:In the current prospective study, 3527 patients with multiple trauma were recruited according to the guideline of emergency medicine. Information on age, gender, pelvic pain or tenderness, sacrum and coccyx pain or tenderness, the ability to active straight leg raising (SLR), and distracting injury was collected, and PF was examined by either X-ray or computed tomography (CT) scan.Results:The CSS sensitivity of NPF was 39.75% and the specificity was 100%. The no distracting injury was not significantly different according to the CSS criteria and results of X-ray and CT scan (P = 0.269); however, the difference of other criteria was significant (P < 0.0001). No pelvic pain or tenderness and the ability to active SLR considerably affected the prediction of NPF (P < 0.0001). No distracting injury can be omitted from the criteria without any effect on specificity, but with increased sensitivity (60.8% with three criteria vs. 39.7% with four criteria).Conclusion:According to our results, it can be said that due to the high predictive value of our suggestive criteria, it could be applicable as the important criteria for defecting NPF among patients with the possibility of PF. This approach can reduce the necessity of imaging in these patients which helps to reduce the health cost and hazards of X-ray used for imaging and exhaustion of medical devices.

Open Pelvic Fractures: Review of 30 Cases.

Background:Open pelvic fractures are rare but usually associated with a high incidence of complications and increased mortality rates. The aim of this study was to retrospectively evaluate all consecutive open pelvic fractures in patients treated at a single Level-1 Trauma Center during a 10-year interval.Patients and Methods:In a 10-year interval, 30 patients with a diagnosis of open pelvic fracture were admitted at a Level-1 Trauma Center. A retrospective analysis was conducted on data obtained from the medical records, which included patient’s age, sex, mechanism of injury, classification of the pelvic lesion, Injury Severity Score (ISS), emergency interventions, surgical interventions, length of hospital and Intensive Care Unit stay, and complications, including perioperative complications and death. The Jones classification was used to characterize the energy of the pelvic trauma and the Faringer classification to define the location of the open wound. Among the survivors, the results were assessed in the last outpatient visit using the EuroQol EQ-5D and the Blake questionnaires. It was established the relationship between the mortality and morbidity and these classification systems by using the Mann-Whitney non-parametric test, with a level of significance of 5%.Results:Twelve (40%) patients died either from the pelvic lesion or related injuries. All of them had an ISS superior to 35. The Jones classification showed a direct relationship to the mortality rate in those patients (p = 0.012). In the 18 (60%) other patients evaluated, the mean follow-up was 16.3 months, ranging from 24 to 112 months. Eleven (61%) patients had a satisfactory outcome. The Jones classification showed a statistically significant relationship both to the objective and subjective outcomes (p < 5%). The Faringer classification showed a statistically significant relationship to the subjective, but not to the objective outcome. In addition, among the 18 patients evaluated at the last outpatient visit, the Faringer classification showed statistical significance on the need of colostomy (p = 0.001) in the acute phase of treatment.Conclusion:We suggest the routine use of the Jones classification for the emergency room assessment and management of all open fractures of the pelvic ring. We believe the Faringer classification seems to be useful for the abdominal surgeons for the indication of gut transit derivation but not for the acute management of the bony component of an open pelvic fracture.

Prevalence of exclusively and concomitant pelvic fractures at magnetic resonance imaging of suspect and occult hip fractures.

Pelvic fractures may occur together with hip fractures as a result of low energy trauma. It is unclear whether they do require special attention. There are conflicting results in the literature about the prevalence of both concomitant hip and pelvic fractures as well as exclusive pelvic fractures. It has been reported that hip fractures and obturator ring fractures are mutually exclusive. To retrospectively analyze the prevalence of exclusively pelvic as well as concomitant hip and pelvic fractures in patients examined with MRI after low-energy trauma in elderly. During 9 years, 316 elderly patients had been examined with MRI for suspected or occult hip fracture after a fall. A fracture was diagnosed when MRI showed focal signal abnormalities in the subcortical bone marrow, with or without disruption of adjacent cortices. One observer reviewed all studies. A second observer verified all studies with hip fractures. Follow-up was available for all but two patients that died prior to hip surgery. The prevalence of concomitant pelvic and femoral neck or trochanteric fractures was statistically compared using chi-squared test for categorical variables. Hip fractures were found in 161 (51 %) patients of which 29 (9 %) had concomitant pelvic fractures. There were exclusively pelvic fractures in 82 (26 %) patients of which 65 (79 %) were on the traumatized side only. In 73 patients, there were no fractures. Occult or suspected hip fractures are not infrequently associated with pelvic fractures. Exclusively pelvic fractures are not uncommon.

The incidence of pelvic fractures with traumatic lower limb amputation in modern warfare due to improvised explosive devices

A frequently-seen injury pattern in current military experience is traumatic lower limb amputation as a result of improvised explosive devices (IEDs). This injury can coexist with fractures involving the pelvic ring. This study aims to assess the frequency of concomitant pelvic fracture in IED-related lower limb amputation. A retrospective analysis of the trauma charts, medical notes, and digital imaging was undertaken for all patients arriving at the Emergency Department at the UK military field hospital in Camp Bastion, Afghanistan, with a traumatic lower limb amputation in the six months between September 2009 and April 2010, in order to determine the incidence of associated pelvic ring fractures. Of 77 consecutive patients with traumatic lower limb amputations, 17 (22%) had an associated pelvic fracture (eleven with displaced pelvic ring fractures, five undisplaced fractures and one acetabular fracture). Unilateral amputees (n = 31) had a 10% incidence of associated pelvic fracture, whilst 30 % of bilateral amputees (n = 46) had a concurrent pelvic fracture. However, in bilateral, trans-femoral amputations (n = 28) the incidence of pelvic fracture was 39%. The study demonstrates a high incidence of pelvic fractures in patients with traumatic lower limb amputations, supporting the routine pre-hospital application of pelvic binders in this patient group.

High Rates of Sexual and Urinary Dysfunction After Surgically Treated Displaced Pelvic Ring Injuries

Pelvic ring injuries may be associated with genitourinary injury (GUI) and result in urinary or sexual dysfunction. We determined (1) incidence of new sexual and urinary dysfunction after surgically treated pelvic ring injuries, (2) association of sexual or urinary dysfunction to fracture type and GUI, and (3) incidence and association between new sexual and urinary dysfunction in male and female patients without GUI. We retrospectively studied 151 patients by postal questionnaire after pelvic reconstruction. Presence, type, and severity of new sexual dysfunction and urinary dysfunction were related to GUI and type of pelvic fracture using the Young and Burgess classification. Minimum followup was 1 year (median, 5 years; range, 1-12 years). New sexual dysfunction occurred in 61 of 143 (43%) and urinary dysfunction in 61 of 150 (41%) responding patients. Neither new sexual nor urinary dysfunction was associated with sex or GUI. In patients with no GUI, new sexual dysfunction was associated with chronologic age (odds ratio [OR], 1.04/year; 95% CI, 1.01-1.07) and pelvic fracture type. Lateral compression injury was less likely to result in new sexual or urinary dysfunction compared with AP type (sexual OR, 1.73; 95% CI, 0.67-4.47; urinary OR, 2.97; 95% CI, 1.15-7.66) and vertical shear type (sexual OR, 2.60; 95% CI, 1.02-6.64; urinary OR, 4.6; 95% CI, 1.81-11.73). Our data suggest new sexual and urinary dysfunction occur at relatively high rates after pelvic fracture in patients with or without GUI. We recommend early assessment and referral for specialist treatment. Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

The Relationship Between Lumbosacral Plexopathy and Pelvic Fractures

This study aimed to investigate the relationship between lumbosacral (LS) plexopathy and pelvic fracture in patients with pelvic fractures only. This study is a retrospective review of patients with pelvic trauma from 1997 to 2007. All patients underwent radiologic examination. The patients with suspected neurologic deficits underwent electrodiagnostic tests. The pelvic fractures were classified based on anatomic location (anterior, lateral, or posterior) and stability (stable, partially stable, or unstable). LS plexopathy was classified based on anatomic quadrant location (upper anterior, upper posterior, lower anterior, or lower posterior) and severity (mild, moderate, or severe) according to electrodiagnostic findings. A total of 104 patients had pelvic fractures only. Thirty-two of those patients (30.8%) had LS plexopathy (26 unilateral and 6 bilateral patients; 38 limbs with LS plexopathy involvement). The incidence and severity of LS plexopathy were found to increase with the increasing number of involved anatomic fracture locations and with fracture instability. Of the 38 limbs affected by LS plexopathy, 34 (89.5%) involved the lower posterior quadrant. Only four cases (10.5%) involved a solitary quadrant, whereas 12 cases (31.6%) involved all quadrants. There was no correlation between fracture location and LS plexopathy quadrant. The incidence and severity of LS plexopathy increases with the increasing number of anatomic fracture locations and with increased fracture instability. LS plexopathy does not correlate with fracture location. LS plexopathy may be the result of both simple direct compression by displaced bone and indirect injury.

Pelvic Fractures in Patients Treated by TAE at a Single Hospital

Pelvic Fractures in Patients Treated by TAE at a Single Hospital

Paediatric pelvic fractures: 10 years experience in a trauma centre

Fractures of the skeletally immature pelvis are relatively rare. We performed a retrospective analysis of 10 years experience of paediatric pelvic fractures in patients admitted a Level 1 Trauma Centre in London. All patients evacuated to the Royal London Hospital by the Helicopter Emergency Medical Service (HEMS) were entered on a comprehensive trauma database. This contains data about the time, date and mechanism of injury; nature of the injuries sustained; Injury Severity Score (ISS), Revised Trauma Score (RTS) and Glasgow Coma Scale (GCS). Patients were studied to obtain the following information in addition to that available from the trauma database: management of the pelvic fracture, length of stay in the intensive care unit and on the ward, and clinical outcome. Pelvic fractures were classified as open type or closed type and stable or unstable type in the database. 44 patients with pelvic fracture were admitted via HEMS in 10 years and seven patients died in that group. The mean age was 11.4 (range 6–16) and 28 male and 16 female patients. Commonest mechanism of injury was pedestrian hit by the car and predominantly stable type of injury was found in skeletally immature pelvis. Commonest associated injury was long bone fracture followed by head injury. ISS, GCS and RTS were significantly ( p < 0.05) altered in the non-survivors compared to the surviving group. All patients save one were treated conservatively allowing gradual mobilisation. In conclusion, pelvic fractures in children may themselves have a good long term outcome with conservative management, but they are an indicator of serious other bodily injuries which carry a high mortality.

Are pelvic radiographs needed in assault victims?

To determine the incidence of acute pelvic fractures in patients with a history of being assaulted. Retrospective review by two musculoskeletal radiologists of 357 consecutive patients in a 12-month period, (308 males, 49 females). Two hundred seventy-six patients also had pelvic CT scans done at the same time. There were no acute pelvic fractures in this group. One patient had a 12th rib fracture and two other patients had a total of three lumbar spine transverse process fractures at the L1, L2, and L5 levels. Pelvic radiographs are not needed as part of standard protocols for patients who present with a history of being assaulted.

Prevalence of Traumatic Hip and Pelvic Fractures in Patients with Suspected Hip Fracture and Negative Initial Standard Radiographs—A Study of Emergency Department Patients

Prevalence of Traumatic Hip and Pelvic Fractures in Patients with Suspected Hip Fracture and Negative Initial Standard Radiographs—A Study of Emergency Department Patients

Prevalence of Traumatic Hip and Pelvic Fractures in Patients with Suspected Hip Fracture and Negative Initial Standard Radiographs—A Study of Emergency Department Patients

To determine the prevalence of hip and pelvic fractures in emergency department (ED) patients with hip pain and negative standard initial radiographs. This was a retrospective, cohort study at an academic, community-based ED. ED patients presenting during a one-year period with hip pain for whom a plain-film radiograph was obtained were included. Eligible patients were identified by query of electronic records. Plain radiographs and magnetic resonance images (MRIs) were ordered at the discretion of the treating physician. Initial plain radiographs were read at the point of care by board-certified radiologists. MRI images were reviewed by radiologists with fellowship training in musculoskeletal imaging. Structured follow-up at more than one month postvisit was conducted to rule out a subsequent diagnosis of hip fracture. Ninety-five-percent confidence intervals (95% CIs) and kappa (kappa) were calculated as appropriate. Seven hundred sixty-four of 895 patients (85.3%) had follow-up completed (study group). Within the study group, 219 patients (29%) had evidence of fracture on initial radiographs. Of the 545 patients with negative initial radiographs, 62 patients (11.4%) underwent hip MRI during the ED visit. MRI identified 24 additional patients with hip fractures. Interobserver agreement for the presence of fracture on MRI was very good (kappa = 0.847). For patients with negative initial plain radiographs who did not have a hip MRI, follow-up did not identify any of these patients as having a subsequent diagnosis of fracture. Thus, 24 of 545 (4.4%; 95% CI = 3.0% to 6.5%) patients with negative initial plain radiographs had a hip fracture. In this cohort of ED patients with symptoms suspicious for hip fracture who had negative standard radiographs, the authors found that 4.4% were subsequently diagnosed as having fracture. Further studies are warranted to identify characteristics of patients requiring advanced hip imaging studies.

Damage Control Orthopaedics

In some groups of polytrauma patients, particularly those with chest injuries, head injuries, and those with mangled extremities, early total care of major bone fractures may be potentially harmful. Delaying all orthopaedic surgery, however, is also not always the best approach. In these situations, damage control orthopaedics, which emphasizes the stabilization and control of the injury rather than repair will add little additional physiologic insult to the patient and is a treatment option that should be considered.

Pelvic Fractures Less Common and Serious in Children Than in Adults

Pelvic fracture is considered to be uncommon in children, but few studies have involved large cohorts. These authors reviewed records from an 18-year period at an Australian pediatric hospital and identified 120 cases of pelvic fracture in patients younger than 16. The cohort had a mean age of 9 years (range, 1-16) and a mean Injury Severity Score of 19.5 (range, 4-89). …

Diagnosis of pelvic fractures in patients with acute pelvic trauma: efficacy of plain radiographs.

Although CT is widely recognized as an important adjunct to plain films in the evaluation of patients with acute pelvic trauma, accurate diagnosis of orthopedic injuries with plain films alone is often important to determine if immediate external fixation is necessary. The purpose of this study was to determine the efficacy of plain radiographs in the detection of pelvic fractures and dislocations in patients with acute pelvic trauma by using CT as the gold standard. CT scans and plain films collected prospectively in 50 patients with acute pelvic injuries were evaluated independently, and fractures and dislocations were identified and tabulated. Of a total of 162 fractures and dislocations seen on CT, only 14 (9%) were misdiagnosed on plain films. None of these misdiagnoses altered patients' management. Sixteen (80%) of 20 cases of intraarticular fragments in the hip joint associated with acetabular fractures were not identified on plain films. We conclude that plain film examination of the patient with pelvic trauma is sufficient to identify virtually all clinically important fractures and dislocations. Plain radiographs alone are not accurate in detecting fracture fragments within the hip joint.