Pelvic Ring Fractures Research Articles

Computed tomography in the assessment of pelvic bone fractures in patients with combined injuries

To date, mortality from a complex pelvic injury remains high. It is noted that the total mortality from pelvic injury is 4.7 %. It is recognized that diagnostic imaging plays a leading role in the treatment of pelvic fractures, and image quality helps to reduce the morbidity and mortality of patients with injuries. The aim of the study was to evaluate the role of CT with three-dimensional reconstruction in the diagnosis of pelvic bone fractures. Material and methods. During the 36-month period, 76 patients of both sexes (54 (71.0 %) men and 22 (29.0 %) women) were examined. The Young-Burgess classification system was used to assess the nature of pelvic fractures. A spiral computed tomograph Aquilion 16 Model TSX-101A (Toshiba, Japan) was used. All patients are scanned in a supine position with no movement during the examination. The scan was started from the top of the iliac crest and continued through the level of the sciatic tubercles. The thickness of the cut and the step of the tomography is 10 mm, the table feed is 15 mm per tube revolution, the pitch is 1.5:1, the scanning time is 20–30 seconds. Results. The average age of the patients was 35.2 ± 1.77 years. The largest share was road injuries – 86.9 %: road accidents – 30.3 %, collisions with a pedestrian – 32.9 %, motorcycle and bicycle accidents – 23.7 %, falling from a height – 13.1 % of patients. Pelvic organ radiography diagnosed a sacral fracture in 33 (43.4 %) patients. Anteroposterior compression (AS) was recorded in 9.2 % of cases, of which AS-I in 7.89 %, AS-II – 1.31 %. Lateral compression was observed in 73.68 % of cases: LC-I – 57.89 %, LC-II – 10.53 %, LC-III – 5.26 %. Vertical shift and mixed mechanical injury were detected in 7.89 and in 7.89 % of cases, respectively. The unclassified fracture was detected in 1.31 % of cases. Pelvic ring fractures were associated with sacral fractures (69 (90.8 %) patients) and with acetabular fractures (63 (82.9 %) cases), in 6 (7.9 %) patients – not associated. Conclusions. In combined injuries, lateral compression injuries of the pelvis were more common, which, in comparison with traditional radiographs, were statistically significantly recognized on CT images (p < 0.001), which confirmed the fact that pelvic fractures are more common in lateral compression injuries than in anteroposterior injuries. For a complete assessment of the pelvic ring, in addition to the pelvic view, a CT scan of the lateral part of the sacrum is required.

P154. Low back pain with surgical and nonsurgical treatment of closed pelvic ring fractures with sacral injuries: a single institutional retrospective review

<h3>BACKGROUND CONTEXT</h3> Sacroiliac joint (SIJ) fusion surgery for chronic back pain has grown in popularity since 2011. A variety of implants have been developed since then to allow surgeons to perform this technique with ease while decreasing complications associated with a new technology. Despite the wide acceptance of this technology, factors that would lead to a satisfactory surgical outcome still remain unclear. Due to the robust mechanical properties of the incongruent sacroiliac joint, one could argue that the joint is truly not unstable. Adding additional stability by fusing the joint that is already stable does not explain why the procedure would be beneficial. Based on the hypothesis that SIJ pain is not necessarily due to mechanical instability, this study will review patients with pelvic trauma who either underwent nonoperative management versus operative management to assess who eventually developed chronic SIJ pain and required further ongoing intervention. For patients who underwent sacroiliac joint fusion, theoretically they should not develop chronic SIJ pain afterward. For patients who were treated nonoperatively, leading to potential mechanical instability, they would be more likely to develop chronic sacroiliac joint pain. This study will either validate or refute the belief that sacroiliac joint dysfunction is truly mechanically related. <h3>PURPOSE</h3> The purpose of this study is to determine if surgery negates the need for additional intervention for SI joint pain and determine if any displacement addressed during surgery contributes to better outcomes for the patient. <h3>STUDY DESIGN/SETTING</h3> This is a retrospective review of patients from a single Level I trauma center. <h3>PATIENT SAMPLE</h3> A total of 68 patients (56% male) from the University of Missouri-Columbia were included between 2015 and 2019. Patients between 18 and 65 years of age who sustained closed pelvic ring fractures with SI joint involvement were included in the study. Exclusion criteria include no contact information listed in chart, history of back pain prior to the injury, lack of appropriate followup radiographs and previous history of lumbar surgery or lumbar surgery as a result of the inciting injury. <h3>OUTCOME MEASURES</h3> The amount of anterior-posterior and vertical displacement were measured both pre- and postsurgery. Patients were separated into surgical and nonsurgical groups, with additional interventions of chiropractic manipulation, narcotics, physical therapy, non-steroidal anti-inflammatory medications and home exercises. <h3>METHODS</h3> Data analysis was performed with student's T test, Wilcoxon rank sum test and Fischer exact test with statistical significance achieved when p <0.05. A stepwise regression model was used to determine if comorbidities are associated with increased interventions in both the surgical and nonsurgical group. <h3>RESULTS</h3> No significant difference was found between the surgical and nonsurgical groups in terms of both demographics and comorbidities. There was also no significant difference between the number of interventions needed for patients treated with or without surgery. Increased comorbidities are not associated with an increased number of interventions needed in either the surgical or nonsurgical group. Additionally, surgery did not significantly decrease the amount of anterior-posterior and vertical displacement as measured on X-rays. <h3>CONCLUSIONS</h3> Conservative management is likely just as effective for certain pelvic ring injuries involving the SIJ. Based on current findings, providing additional mechanical stability for the SIJ does not necessarily provide a greater clinical outcome in these fractures. Therefore, the explanation for the clinical improvement of SIJ fusion in nontrauma patients remains elusive. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Epidemiology of pelvic and acetabular fractures across 12-mo at a level-1 trauma centre.

BACKGROUNDDespite motor-vehicle safety advancements and increasingly rigorous workplace safety regulations, trauma/suicide remains the leading cause of death under the age of 45 in the United Kingdom. To promote centralisation of care and optimisation of major trauma outcomes, in 2012 the National Health Service introduced the Trauma Network System. To our knowledge, this is the first study to analyse the epidemiology of pelvic and acetabular trauma over a one-year period at a level-1 trauma centre in the United Kingdom, since nationwide introduction of the Trauma Network System.AIMTo characterize the epidemiology of high-energy pelvic and acetabular fractures over a one-year period at a level-1 trauma centre, and explore both resources required to care for these patients and opportunities for future research and injury prevention initiatives.METHODS227 consecutive patients at a level-1 trauma centre with pelvic and acetabular fractures were analysed between December 2017-December 2018. Paediatric patients (< 18 years) and fragility fractures were excluded, leaving 175 patients for inclusion in the study. Statistical analysis was performed using Fisher’s exact test for categorical variables.RESULTS72% of pelvic and acetabular fractures occurred in male patients at a median age of 45 years. 15% were the result of a suicide attempt. 48% of patients required pelvic or acetabular surgery, with 38% undergoing further surgery for additional orthopaedic injuries. 43% of patients were admitted to intensive care. The median inpatient stay was 13 days, and the 30- day mortality was 5%. Pelvic ring trauma was more commonly associated with abdominal injury (P = 0.01) and spine fractures (P < 0.001) than acetabular fractures. Vertical shear pelvic ring fractures were associated with falls (P = 0.03) while lateral compression fractures were associated with road traffic accidents (P = 0.01).CONCLUSIONHigh energy pelvic and acetabular fractures are associated with concomitant orthopaedic fractures (most commonly spine and lower limb), intensive care admission and prolonged inpatient stays. Most pelvic ring injuries secondary to road traffic accidents are lateral compression type, demonstrating the need for future research to drive advancements in lateral impact vehicle safety along with mental health surveillance for those deemed to be potential suicide risks.

Clinical utility of minimally invasive posterior internal fixation within the pelvic ring using S2 alar iliac screws for unstable pelvic ring fracture

IntroductionPosterior internal fixation for unstable pelvic ring fractures is often associated with complications, including pelvic hemorrhage and gluteal necrosis. Pelvic ring fixation using the S2 alar iliac screw (SAIS) without fixation of the lumbosacral vertebrae may have potential as a novel, minimally invasive technique for treating unstable pelvic ring fractures. The present study compared clinical outcomes in patients who underwent SAIS fixation within the pelvic ring with a historical control group of patients who underwent conventional trans-iliac plate fixation for the treatment of unstable pelvic ring fractures. Materials and methodsThirty-two patients diagnosed with unstable pelvic fractures with sacral fracture or sacroiliac joint fracture dislocation were retrospectively evaluated. Eight consecutive patients underwent trans-iliac plate fixation from April 2012 to March 2015, and 24 consecutive patients underwent SAIS fixation from April 2015 to February 2020. Rates of soft tissue complications, intraoperative blood loss, and intraoperative blood transfusion volume were compared in these two groups. ResultsMean intraoperative blood loss was significantly lower in patients who underwent SAIS fixation than in those who underwent trans-iliac plate fixation (141.0 ml vs 315.0 ml; P = 0.027), although there were no between-group differences in intraoperative blood transfusion volume (0.0 ml vs 140 ml; P = 0.105), incidence rate of soft tissue complications (4.2% vs 0%; P = 1.000), and operation time (88.5 min vs 93.0 min; P = 0.862). Bone healing was confirmed in all patients who underwent SAIS fixation without dislocation of the fracture site, whereas one patient who underwent trans-iliac plate fixation experienced a dislocation of the fracture site during follow-up (0% vs 12.5%; P = 0.250). ConclusionsSAIS fixation reduces intraoperative blood loss and ensures bone healing without major complications, including dislocation of the fracture site. SAIS fixation may therefore be an alternative, minimally invasive method of treating unstable pelvic fractures.

The impact of specific fracture characteristics of low-energy fractures of the pelvis on mortality

BackgroundPelvic fractures in older patients are associated with relevant morbidity and mortality. Both might be determined by fracture morphology and/or patient characteristics. The aim of this project is to investigate the prognostic value of specific fracture characteristics with respect to overall survival and to compare it with an established classification system.MethodsRetrospective analysis of patients ≥ 60 years, treated conservatively for a CT-scan verified, low-energy pelvic ring fracture between August 2006 and December 2018. Survival data was available from patients’ charts and cantonal or national registries.The prognostic value of fracture characteristic describing the anterior and posterior involvement of the pelvic ring was investigated. This analysis was repeated after patients were stratified into a high-risk vs a low-risk group according to patient characteristic (age, gender, comorbidities, mobility, living situation). This allowed to assess the impact of the different fracture morphologies on mortality in fit vs. frail senior patients separately.ResultsOverall, 428 patients (83.4% female) with a mean age of 83.7 years were included. Two thirds of patients were still living in their home and mobile without walking aid at baseline. In-hospital mortality was 0.7%, overall, one-year mortality 16.9%. An independent and significant association of age, gender and comorbidities to overall survival was found. Further, the occurrence of a horizontal sacral fracture as well as a ventral comminution or dislocation was associated with an increased mortality. The effect of a horizontal sacral fracture was more accentuated in low-risk patients while the ventral fracture components showed a larger effect on survival in high-risk patients.ConclusionSpecific fracture characteristics may indicate a higher risk of mortality in conservatively treated patients with a low-energy pelvic ring fracture. Hence, they should be taken into account in future treatment algorithms and decisions on patient management.

Does navigation still have avalue in trauma surgery?

Navigation systems are supposed to increase precision and support surgeons while they perform certain interventions. 2D, or nowadays 3D, systems are used in image-based approaches. Image-free navigation uses 3D printing. There are several studies on navigation procedures in trauma surgery. In contrast to limb surgery, the use of 3D navigation in pelvic and spine surgery is already well established. Navigation is especially regularly used to treat fractures of the posterior pelvic ring and for posterior stabilization of the cervical spine. To be able to utilize navigation systems optimally, the learning curve should be completed, and the technique should be used regularly. In addition, the surgeon should know the surgical technique without navigation in order to recognize potential errors of the navigation. Advantages include increased patient safety, reduction in radiation exposure and less invasive surgical procedures. However, among other disadvantages, initial costs are high.

Routine Postoperative Computed Tomography Scans Following Posterior Pelvic Fixation of Pelvic Ring Fractures: A Survey of (OTA) Orthopaedic Traumatologists.

To assess practices related to ordering computed tomography (CT) scans routinely after posterior pelvic ring fixation and revision surgery rates. A 20-question cross-sectional survey. Fellowship-trained orthopaedic traumatologists. (1) Percentage of surgeons ordering a routing postoperative CT after posterior pelvic ring fixation, (2) Revision surgery rates based on routine CT scan results. Responses were received from 57 surgeons. Practices varied regarding postoperative CT scans, with 20 surgeons (35%, group A) routinely ordering them and 37 surgeons (65%, group B) not ordering them on all patients. Group A were younger and with less years of experience than those in Group B. Most group A surgeons report a revision surgery rate of <1% based on results of the postoperative CT. Group A report routine postoperative scans were obtained to assess reduction, instrumentation placement, and for educational purposes. Group B did not obtain routine postoperative CTs because of the following: unlikely to change postoperative treatment course, adequate reduction and instrumentation placement assessed intraoperatively and by postoperative radiographs, and increased radiation exposure and cost to patients. Group B did report obtaining postop CT scans on select patients, with postoperative neurological deficit being the most common indication. The routine use of postoperative CTs following posterior fixation of pelvic ring fractures is a controversial topic. Although we recognize the role for postoperative CT scans in select patients, our study questions the clinical utility of these scans in all patients and in conclusion do not recommend this protocol.

Is Percutaneous Screw Fixation with 6.5 mm Cannulated Cancellous Screws a Viable Option in Pelvic Ring Fractures?

Background Historically, internal fixation in pelvic ring fractures has been proven to be better in outcome than both external fixation and conservative management. In an attempt to overcome the morbidity of extensile surgical approaches, percutaneous fixation of the pelvis has been receiving increasing attention. The aim of the study was to assess the functional outcome in patients with pelvic ring fractures treated with percutaneous screw fixation. Methods The study included 12 patients of pelvic ring fracture admitted at NSCB medical college, Jabalpur (Madhya Pradesh) from December 2019 to October 2021, all treated percutaneously with cannulated cancellous screw fixation. Four patients had Tiles type C1 injury, 4 patients with type C2, 2 with type B1 and 2 with type A2 injury. Functional assessment was done using the Majeed Scoring system at preoperative, at 3 weeks, 6 weeks, and 3 months postoperatively. Results Functional outcome score at 3-month follow-up was poor in 8% patients, fair in 8% patients, good in 33.3% patients, and excellent in 50% patients. Pain was the most frequent complaint on follow-up. Conclusion Fixation of acute pelvic ring injuries with 6.5 mm cc screws using percutaneous technique offers favorable functional outcome and can be performed in hemodynamically unstable patients.

Correction to: Immediate full weight bearing after pelvic percutaneous fixation by screw for simple acetabular and pelvic ring fractures in patients older than sixty five years

Correction to: Immediate full weight bearing after pelvic percutaneous fixation by screw for simple acetabular and pelvic ring fractures in patients older than sixty five years

Immediate full weight bearing after pelvic percutaneous fixation by screw for simple acetabular and pelvic ring fractures in patients older than sixty fiveyears.

The aim of this study was to assess the walking and weight-bearing abilities of patients older than 65years with a simple acetabular or pelvic ring fracture treated with pelvic percutaneous screwing (PPS). This study included 27 patients. This was a retrospective, single-centre observational study conducted in a level 1 trauma centre from September 2019 to April 2021. All patients older than 65years who underwent PPS for an acetabular or pelvic ring fracture were included. All patients were able to walk and bear weight at oneday after PPS. The mean walking distance increased from 19.4m the day after the operation to 59.8m, 497.8m, and 1402m at discharge, three and sixweeks after the operation, respectively. The average pain visual analog scale scores before and after the operation were 4.1 (range, 3.6-5.1; standard deviation [SD], 0.63) and 0.9 (range, 0.5-1.2; SD, 0.25), respectively (p < .0001). The average daily dose of paracetamol used before and after the operation was 2.2 (range, 1.7-3.1; SD, 0.59) g/d and 1.3 (range, 0.6-1.7; SD, 0.40) g/d, respectively (p = .0232). The average daily dose of morphine used before and after the operation was 5.7 (range, 4.7-6.7; SD, 0.76) mg/d and 1.6 (range, 0.5-2.9; SD, 1.09) mg/d, respectively (p = .0001). All included patients were able to walk at one day after PPS. PPS was associated with reduced pain as well as a reduction in paracetamol and morphine use.

Quantification and visualization of anterior pelvis bone density to optimize screw fixation: A novel technique.

Plate fixation of anterior pelvic ring fractures is often a vital component when surgically treating unstable pelvis fractures. Certain plate and screw configurations can have premature implant loosening, potentially in part due to insufficient pullout strength in lower density bone. This study sought to define densities about the anterior pelvic ring using a novel computer-based technique. Thirty-three patients who received a computed tomography (CT) of the abdomen/pelvis for reasons other than pelvis fracture in a 1-month time period were included. Three statistically distinct density regions of the anterior pelvis were identified based on the three-dimensional (3D) density map. The densest regions included both the anterior and posterior aspects of the superior pubic ramus, along with the region of bone along the inferior cotyloid fossa. The intermediate density region included the caudal and medial pubic body. The least dense region included the anterior aspect of the inferior pubic ramus (IPR), the posterior pubic body, and the posterior/inferior IPR. This study presents specific quantification of anterior pelvis bone density based on a novel technique using opportunistic CT scans. Clinical Significance: Anterior surgical fixation of unstable pelvic ring injuries may benefit from targeting areas of higher density as described in this novel technique.

Infected pseudarthrosis of the symphysis with persisting instability : Revision osteosynthesis with tantalum cage and silver ionized ITS plate after peri-implant infection with MRSE after osteosynthetic stabilization of atypeC pelvic injury

Overall symptomatic pseudathrosis after pelvic ring fracture is rare. A pseudarthrosis of the dorsal pelvic ring often leads to persisting pain due to instability and needs a consequent treatment strategy. Often a bacterial infection can be found in persisting pseudarthrosis notably in the anterior pelvic ring region. It is assumed that the peculiar anatomical site of the surgical approach - pubic region and abdominal skinfold - in particular accompanied with adipositas is predestined. Often patients with pseudathrosis and proof of bacterial infection show no symptoms. In these cases treatment is not mandatory. Patients however who complain about persisting pain limited treatment options exist.The following case report demonstrates atreatment strategy to achieve pelvic ring stability and infection eradication using a silver ionised plate and screws as well as a tantalum cage.

Focusing on individual morphological fracture characteristics of pelvic ring fractures in elderly patients can support clinical decision making

IntroductionPelvic ring fractures in the elderly are often caused by minor trauma. Treatment of these patients is currently based on fracture classification, clinical course, and ability to mobilize. Our aim was to identify morphological fracture characteristics with potential prognostic relevance and evaluate their association with clinical decision making and outcome, as well as their interobserver reliability.MethodsFive fracture characteristics were investigated as potential variables: 1. Extent of the dorsal pelvic ring fracture (absent, unilateral, bilateral); 2. Extent of the ventral pelvic ring fracture (absent, unilateral, bilateral); 3. Presence of a horizontal sacral fracture; 4. Ventral dislocation; 5. Ventral comminution.These characteristics were assessed retrospectively in a series of 548 patients. The association of their presence with the decision to perform surgery, failure of conservative treatment and the length of hospital stay (LOS) was determined. Further, the inter-observer reliability for the specific characteristics was calculated and the relation with survival assessed.ResultsFour of the five evaluated characteristics showed an association with clinical decision making and patient management. In particular the extent of the dorsal fractures (absent vs. unilateral vs. bilateral) (OR = 7.0; p < 00.1) and the presence of ventral comminution/dislocation (OR = 2.4; p = 0.004) were independent factors for the decision to perform surgery. Both the extent of the dorsal fracture (OR = 1.8; p < 0.001) and the presence of ventral dislocation (OR = 1.7; p = 0.003) were independently associated with a prolonged overall LOS.The inter-observer agreement for the fracture characteristics ranged from moderate to substantial.A relevant association with increased mortality was shown for horizontal sacral and comminuted ventral fractures with hazard ratios (HR) of 1.7 (95% CI: 1.1, 2.5; p = 0.008) and HR = 1.5 (95% CI: 1.0, 2.2; p = 0.048).ConclusionIn the elderly, the extent of the dorsal fractures and the presence of ventral comminution/dislocation were associated to the decision to undergo surgery, failure of conservative treatment and length of stay. Survival was related to horizontal sacral fractures and ventrally comminuted fractures. These characteristics thus represent a simplified but highly informative approach for the evaluation of pelvic ring fractures in the elderly. This approach can support clinical decision making, promote patient-centred treatment algorithms and thus improve the outcome of individualized care.

Transiliac Cerclage in Unstable Pelvic Ring Fractures.

To evaluate the outcomes of transiliac cerclage with Dall-Miles cable in the internal fixation of the posterior complex in unstable pelvic ring fractures between January 1995 and December 2014. A study of 42 men injured at work with an average age of 35.2 years (range, 23 to 61) was conducted. The mechanisms of injury were traffic accidents in 25 cases (59.5%), crushing accidents in 12 cases (28.6%), and fall from height in 5 cases (11.9%). Thirty-six cases were polytraumatized patients (85.7%). The patients were evaluated using Majeeds functional score and Mattas radiological criteria. The average follow-up time was 135.8 45.6 months. The clinical outcomes were excellent in 17 cases (40.5%), good in 19 cases (45.2%), fair in 5 cases (11.9%), and poor in 1 case (2.4%). The radiological outcomes were satisfactory in 32 cases (76.2%) and unsatisfactory in 10 cases (23.8%). All fractures were healed. The sequelae were 3 cases (7.2%) of lower limb dysmetria and 3 cases (7.2%) of chronic neuropathic pain. The internal fixation of the sacroiliac complex by Dall-Miles cable cerclage reinforced with small fragment plates should be considered as an alternative method for minimally invasive osteosynthesis in selected cases of unstable pelvic ring fractures.

Early Outcome Analysis of Management of Closed Pelvic Ring Fractures in Emergency: Conservative Versus Surgical at Level III Trauma Center in India.

Introduction: Pelvic bone fracture is often observed in high-speed road traffic accidents, and forms a medical emergency as it is often complicated with associated internal exsanguination, shock, and mortality. Managing such cases cost-effectively in a developing country with limited assets, without compromising on patient outcomes still remains an obstacle.Objective: To compare and contrast the clinical aftermath of urgent non-surgical and surgical treatment of closed pelvic ring fracture patients and to analyze the types and severity of complications and final functional outcome.Material and methods: Twenty-five patients with pelvic fractures received at the casualty of IMS and SUM Hospital, Bhubaneswar, between January 2017 and January 2018 were included in the study. Marvin Tile classification was used to classify the fractures. Analysis and assessment of patients were done preoperatively and at six-month follow-up after management, with radiology and functional score using D’Aubinge-Postel Scale. The mode of injury, various management protocols for each type of fracture pattern, and associated complications were also noted. And finally, an outcome comparison was drawn between surgical and non-surgical options for various fractures. A Chi-square test was used to compare the outcomes.Results: The functional outcome as per the D'Aubigne-Postel Scale, on average six months, was excellent in nine patients (36%), good in seven (28%), fair in four (16%), and poor in four (16%). The outcome comparison was insignificant statistically in both radiological assessment (p 0.614) and functional scores (p 0.26) between the conservative and surgical outcomes. The average duration of hospital stay, duration to ambulation, duration to full recovery, and complications were significantly more in patients managed conservatively. While the cost of treatment was more in the surgical group. One death was observed in the study group due to septicemia which might have been directly related to the severity of pelvic injury and choice of treatment.Conclusion: Tile’s Type B and C fractures, managed surgically allow faster mobilization of the patient and a shorter recovery period while the cost of treatment is significantly more. Tiles type A is best managed conservatively.

Generation of hemipelvis surface geometry based on statistical shape modelling and contralateral mirroring

Personalised fracture plates manufactured using 3D printing offer an improved treatment option for unstable pelvic ring fractures that may not be adequately secured using off-the-shelf components. To design fracture plates that secure the bone fragments in their pre-fracture positions, the fractures must be reduced virtually using medical imaging-based reconstructions, a time-consuming process involving segmentation and repositioning of fragments until surface congruency is achieved. This study compared statistical shape models (SSMs) and contralateral mirroring as automated methods to reconstruct the hemipelvis using varying amounts of bone surface geometry. The training set for the geometries was obtained from pelvis CT scans of 33 females. The root-mean-squared error (RMSE) was quantified across the entire surface of the hemipelvis and within specific regions, and deviations of pelvic landmarks were computed from their positions in the intact hemipelvis. The reconstruction of the entire hemipelvis surfaced based on contralateral mirroring had an RMSE of 1.21 ± 0.29 mm, whereas for SSMs based on the entire hemipelvis surface, the RMSE was 1.11 ± 0.29 mm, a difference that was not significant (p = 0.32). Moreover, all hemipelvis reconstructions based on the full or partial bone geometries had RMSEs and landmark deviations from contralateral mirroring that were significantly lower (p < 0.05) or statistically equivalent to the SSMs. These results indicate that contralateral mirroring tends to be more accurate than SSMs for reconstructing unilateral pelvic fractures. SSMs may still be a viable method for hemipelvis fracture reconstruction in situations where contralateral geometries are not available, such as bilateral pelvic factures, or for highly asymmetric pelvic anatomies.

Current Concepts in Pediatric Pelvic Ring Fractures: A Narrative Review

Trauma is still the leading cause of death in children. Post mortem studies have shown a high incidence and a high rate of deaths related to pelvic fractures and associated injuries. The pelvic ring in children has characteristics that differentiate it from the adult. The bone tissue is more elastic and is covered with a thick periosteum. Elasticity mainly translates into plastic deformity when it is impacted. Overall, lesions tend to be more stable as the relatively thick periosteum limits bone breakdown. As a result of this elasticity, the intrapelvic organs are more vulnerable and injuries can occur in the absence of fractures. High energy is required to produce a fracture and this energy can be transferred to the pelvic organs. Minimally displaced fractures may be the result of high energy trauma with a significant risk of further intrapelvic and intra-abdominal injury. This leads to a relatively high incidence of pelvic and abdominal organ injuries associated with stable fractures. A complete lesion of the pelvic ring anteriorly or posteriorly or a complex pelvic lesion is a high risk factor for morbidity and mortality. Treatment in the pediatric patient with a pelvic fracture has historically been guided by concepts that have become established in adults. The main parameters in the decision making process are hemodynamic stability and the degree of mechanical instability of the pelvis. The purpose of this review is to report current knowledge on pelvic ring fractures with a particular focus on their management and treatment.

Low-energy fractures of the pelvis in the elderly and mortality

Abstract Objective While the prognostic impact of hip fractures in the elderly is widely accepted, the risk and excess mortality associated with pelvic fragility fractures is still underestimated and receives considerably less attention. Morbidity and mortality might thereby be related to fracture morphology and/or patient characteristics. The aim of this project is to investigate the prognostic value of specific fracture characteristics with respect to overall survival and to compare it with an established classification system. Methods Retrospective analysis of patients ≥60 years, treated conservatively for a CT-scan verified, low-energy pelvic ring fracture diagnosed between August 2006 and December 2018. Survival data was available from patients’ charts and cantonal or national registries. The prognostic value of fracture characteristic describing the anterior and posterior involvement of the pelvic ring was investigated. This analysis was repeated after patients were stratified into a high-risk vs a low-risk group according to patient characteristic (age, gender, comorbidities, mobility, living situation). This allowed to assess the impact of the different fracture morphologies on mortality in fit vs. frail senior patients separately Results Overall, 428 patients (83.4% female) with a mean age of 83.7 years were included. Two thirds of patients were still living in their home and mobile without walking aid at baseline. In-hospital mortality was 0.7%, overall, one-year mortality 16.9%. An independent and significant association of age, gender and comorbidities to overall survival was found. Further, the occurrence of a horizontal sacral fracture as well as a ventral comminution or dislocation was associated with an increased mortality. The effect of a horizontal sacral fracture was more accentuated in low-risk patients while the ventral fracture components showed a larger effect on survival in high-risk patients. No association of the FFP classification with survival was observed. Conclusion Specific fracture characteristics such as horizontal sacral fracture, comminuted and dislocated ventral fractures may indicate a higher mortality risk of patients with a pelvic fragility fracture. Hence, they should be taken into account in future treatment algorithms and decisions on patient management.

Professional Reintegration after Pelvic and Acetabular Trauma

Introduction: Pelvic ring and acetabulum injuries are complex injuries varying in severity and complications resulting in serious morbidity in surviving individuals which as a result can be a major contributor to reintegration of patients in professional services. Therefore its important to evaluate to what extent affected patients can return to pre injury work status and how their quality of life is affected. The objective of this study is to evaluate reintegration of affected patients in profession in a two year follow up after acetabular and pelvic ring injuries Material and Methods: Using local Trauma Registry of Orthopedic Trauma department in Shaheed Mohtarma Benazir Bhutto Institute of Trauma (SMBBIT) a retrospective Cohort study was conducted. All patients between age 18 to 60 who had a Acetabulum or Pelvic Ring fracture presented in SMBBIT during July 2017 to July 2019 and were treated by Orthopedic Trauma department were included in study. Multivariate logistic regression analysis was used to model reintegration to profession. Affected patients were classified as “Reintegrated to profession” if they have earned a month salary after 13 to 24 months rehabilitation post treatment. For unemployed patients along with majority of women who were domestic home makers, reciprocate basic household chores to pre injury injury level were classified as “ Reintegrated “ Fracture classification, Age, Gender, Fracture of Spine , Nerve Injuries of Lumbo Sacral Spine and/or lower limb and work status before injury were considered prognostic covarities. Results: Almost 70 percent of 180 researched patients were classified reintegrated. This means a reduction of 20 percent in employment for Pelvic ring injuries and 10 percent reduction in employment for acetabular fractures post treatment. Employment status before injury was the main predictor for reintegration. Older patients had a less chance to return to work in comparison to young individuals. Patients with Nerve injuries and fracture of spine had almost 80 percent higher risk for not being reintegrated. Conclusion: Acetabular fractures and Pelvic ring injuries currently lead to greater loss of reintegration to profession or domestic work. Trauma to Pelvis and Acetabulum threatens the social security of patients. Therefor rehabilitation and follow up care should be optimized to reduce post traumatic disability and reduce the economic burden of work disability.

Cement augmentation in pelvic ring fractures

Cement augmentation of sacroiliac (SI) screws in the posterior pelvic ring has been shown to provide greater biomechanical stability in cadaveric studies. Pelvic ring fractures are relatively rare compared to the total number of fractures. Nevertheless, the 1‑year mortality rate of up to 27% is very high, especially for geriatric pelvic ring fractures and is also largely associated with reduced mobility due to the fracture. The primary goal of treatment is therefore the restoration of patient mobility. This requires the achievement of sufficient stability of the pelvic ring. As osteoporosis is often acausative factor for the pelvic ring fracture, amore stable anchoring of the implants in the osteoporotic bone can be achieved by cement augmentation. This article presents the possibilities of cement augmentation of the pelvic ring and describes the technique of cement-augmented SI screws.