A Survey to Assess Agreement Between Pelvic Surgeons on the Outcome of Examination Under Anesthesia for Lateral Compression Pelvic Fractures

Carney, John; Nguyen, Andrew; Alluri, Ram K.; Lee, Adam K.; Marecek, Geoffrey S.

doi:10.1097/bot.0000000000001759

Cited by 18 publications

(28 citation statements)

References 27 publications

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“…80% of surgeons now agreed on what constituted a stable or unstable injury pattern. 19 In theory the gold standard would appear to be EUA of all LC type injuries to assess stability. LC-1 pelvic ring injuries are the most common pelvic ring injury.…”

Section: Lateral Compression Fracturesmentioning

confidence: 99%

Assessment of instability in type B pelvic ring fractures

Grewal

Mir

2020

Journal of Clinical Orthopaedics and Trauma

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Pelvic ring fractures have increased in incidence and operative fixation over the past several decades. These are dynamic injuries but decisions on operative management are still often made on the basis of static imaging. Expert opinion varies greatly on which injuries require fixation and how much fixation. Examination under anaesthesia has been shown to guide management of pelvic injuries by more accurately assessing levels of instability.

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Section: Lateral Compression Fracturesmentioning

confidence: 99%

Assessment of instability in type B pelvic ring fractures

Grewal

Mir

2020

Journal of Clinical Orthopaedics and Trauma

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“…Despite a high reported agreement in treating LC-1 fractures/Tile B fractures 20 (comparable to FFP II)—representing the most common fracture type in the elderly 21 —the disagreement found in the survey analysis of Beckmann et al 22 highlights the differing treatment for a similar fracture type. 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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“…However, even if the patients had a stable pelvic ring, the procedure under anesthesia could not be omitted before selecting an identified conservative treatment. In addition, there remains no clear consensus among surgeons regarding the method of performing exams under anesthesia or the definition of a positive exam under anesthesia [ 23 ]. The present finite element analysis provided a basic theory for stability in LC-1 fractures to increase confidence in distinguishing between stable and unstable fractures.…”

Section: Discussionmentioning

confidence: 99%

The morphological mapping of lateral compression type 1 pelvic fracture and pelvic ring stability classification: a finite element analysis

et al. 2021

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Purpose This finite element analysis assessed lateral compression (LC-1) fracture stability using machine learning for morphological mapping and classification of pelvic ring stability. Methods Computed tomography (CT) files of LC-1 pelvic fractures were collected. After morphological mapping and producing matrix data, we used K-means clustering in unsupervised machine learning to classify the fractures. Based on these subtypes, we manually added fracture lines in ANSYS software. Finally, we performed a finite element analysis of a normal pelvis and eight fracture subtypes based on von Mises stress and total deformation changes. Results A total of 218 consecutive cases were analyzed. According to the three main factors—zone of sacral injury and completion, pubic ramus injury side, and the sagittal rotation of the injured hemipelvis—the LC-1 injuries were classified into eight subtypes (I–VIII). No significant differences in stress or deformation were observed between unilateral and bilateral public ramus fractures. Subtypes VI and VIII showed the maximum stress while subtypes V–VIII showed the maximum deformation in the total pelvis and sacrum. The subtypes did not differ in superior public ramus deformation. Conclusions Complete fracture of sacrum zones 2/3 may be a feature of unstable LC-1 fractures. Surgeons should give surgical strategies for subtypes V–VIII.

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A Survey to Assess Agreement Between Pelvic Surgeons on the Outcome of Examination Under Anesthesia for Lateral Compression Pelvic Fractures

Cited by 18 publications

References 27 publications

Assessment of instability in type B pelvic ring fractures

Assessment of instability in type B pelvic ring fractures

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

The morphological mapping of lateral compression type 1 pelvic fracture and pelvic ring stability classification: a finite element analysis

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