A Prospective Clinical Trial Comparing Surgical Fixation Versus Nonoperative Management of Minimally Displaced Complete Lateral Compression Pelvis Fractures

Slobogean, Gerard P.; Gaski, Greg E.; Nascone, Jason W.; Sciadini, Marcus F.; Natoli, Roman M.; Manson, Theodore T.; Lebrun, Christopher; McKinley, Todd O.; Virkus, Walter W.; Sorkin, Anthony T.; Brown, Krista; Howe, Andrea; Rudnicki, Joshua; Enobun, Blessing; O’Hara, Nathan N.; Gill, Jeff

doi:10.1097/bot.0000000000002088

Cited by 23 publications

(28 citation statements)

References 17 publications

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“…Thirty-five of the 37 isolated injuries had good or excellent Majeed outcome scores, and none of the 36 patients with radiographic follow-up experienced displacement >10 mm. 21 In the highest level-of-evidence study to-date, Slobogean et al 22 performed a prospective trial of 95 LC injuries and found that on average the operative group had a statistically significant but clinically dubious improvement in pain and patient reported outcome measures during the first 12 weeks that persisted up to 12-month follow-up. However, the major limitation of these studies, along with a majority of the literature on this subject, is the lack of differentiation of early outcomes between patients with and without displacement on stress radiographs.…”

Section: Discussionmentioning

confidence: 99%

Rami Comminution Is Associated With Displacement of Minimally Displaced Lateral Compression Type 1 Injuries on Lateral Stress Radiographs

Hadeed

Tucker

Heare

et al. 2022

Journal of Orthopaedic Trauma

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Objectives: To determine whether displacement on lateral stress radiographs (LSRs) in patients with minimally displaced lateral compression type 1 pelvic ring injuries is associated with any demographic and/or injury characteristics. Design: Retrospective comparative cohort. Setting: Urban level 1 trauma center. Patients/Participants: Ninety-three consecutive patients with minimally displaced lateral compression type 1 injuries. Intervention: Displacement of pelvic ring injury on LSR (≥10 mm vs. <10 mm). Main Outcome Measurements: Demographic and injury characteristics (mechanism of injury, Nakatani rami classification, rami comminution, Denis zone, complete/incomplete sacral fracture, sacral comminution). Results: 65.6% of patients (n = 61) had ≥10 mm of displacement on LSR. On univariate analysis, displacement was associated with increased age [median difference 11: confidence interval (CI), 2–23], female sex [proportional difference (PD): 25.1%, CI, 3.9%–44.4%], Nakatani classification (type I PD: 27.9%, type II PD: −19.5%), and rami comminution (PD: 55.6%, CI, 35.4%–71.3%). On multivariate analysis, displacement was only associated with rami comminution (odds ratio: 16.48, CI, 4.67–58.17). Displacement was not associated with energy of injury mechanism, sacral fracture Denis zone, complete sacral fracture, sacral comminution, or bilateral rami fractures. Conclusions: Although rami comminution was the only variable found to be independently associated with displacement ≥10 mm on LSR, no single variable perfectly predicted displacement. Future studies are needed to determine whether displacement on stress radiographs should change the management of these injuries. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Rami Comminution Is Associated With Displacement of Minimally Displaced Lateral Compression Type 1 Injuries on Lateral Stress Radiographs

Hadeed

Tucker

Heare

et al. 2022

Journal of Orthopaedic Trauma

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“…However, despite this limitation, the BPI and Majeed Pelvis Outcome Score have been widely used in previous fracture research. 16,24,25 As with all prospective clinical research, written informed consent was required for all participants. Meaningful differences in the patients who refused to consent for this study could potentially introduce selection bias.…”

Section: Discussionmentioning

confidence: 99%

Prospective Characterization of Pain and Function in Patients With Unstable Pelvic Fractures Treated With Posterior Screw Fixation

O’Hara

Sim

Moore

et al. 2022

Journal of Orthopaedic Trauma

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“…To improve the treatment, the examination under anesthesia (EUA) for lateral compression fractures was introduced, but their interpretation shows a relevant disagreement 23 . Furthermore, the deduced treatment and the consensus might change upon newer data 24 – 26 .…”

Section: Discussionmentioning

confidence: 99%

A computed tomography based survey study investigating the agreement of the therapeutic strategy for fragility fractures of the pelvis

Pieroh

Hohmann

Gras

et al. 2022

Sci Rep

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Treatment recommendations for fragility fractures of the pelvis (FFP) have been provided along with the good reliable FFP classification but they are not proven in large studies and recent reports challenge these recommendations. Thus, we aimed to determine the usefulness of the FFP classification determining the treatment strategy and favored procedures in six level 1 trauma centers. Sixty cases of FFP were evaluated by six experienced pelvic surgeons, six inexperienced surgeons in training, and one surgeon trained by the originator of the FFP classification during three repeating sessions using computed tomography scans with multiplanar reconstruction. The intra-rater reliability and inter-rater reliability for therapeutic decisions (non-operative treatment vs. operative treatment) were moderate, with Fleiss kappa coefficients of 0.54 (95% confidence interval [CI] 0.44–0.62) and 0.42 (95% CI 0.34–0.49). We found a therapeutic disagreement predominantly for FFP II related to a preferred operative therapy for FFP II. Operative treated cases were generally treated with an anterior–posterior fixation. Despite the consensus on an anterior–posterior fixation, the chosen procedures are highly variable and most plausible based on the surgeon’s preference.

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A Prospective Clinical Trial Comparing Surgical Fixation Versus Nonoperative Management of Minimally Displaced Complete Lateral Compression Pelvis Fractures

Abstract: Objective: To compare the early pain and functional outcomes of operative fixation versus nonoperative management for minimally displaced complete lateral compression (LC; OTA/AO 61-B1/B2) pelvic fractures.

Cited by 23 publications

References 17 publications

Rami Comminution Is Associated With Displacement of Minimally Displaced Lateral Compression Type 1 Injuries on Lateral Stress Radiographs

Rami Comminution Is Associated With Displacement of Minimally Displaced Lateral Compression Type 1 Injuries on Lateral Stress Radiographs

Prospective Characterization of Pain and Function in Patients With Unstable Pelvic Fractures Treated With Posterior Screw Fixation

A computed tomography based survey study investigating the agreement of the therapeutic strategy for fragility fractures of the pelvis

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