Lateral compression fracture of the pelvis represents a heterogeneous group of complex 3D patterns of displacement

Khoury, Anthony; Kreder, Hans J.; Skrinskas, T.; Hardisty, Michael; Tile, Marvin; Whyne, Cari

doi:10.1016/j.injury.2007.09.017

Cited by 48 publications

(40 citation statements)

References 13 publications

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“…Both patterns will have varying amounts of anterior pubic root/rami fractures. LC1 represents a broad spectrum of injury, including within the same category minimal ''buckle'' impaction fractures of the anterior sacrum to comminuted sacral fractures that extend to and through the posterior cortex [14]. There is general agreement that fractures displaced more than 1 cm benefit from surgical stabilization, but it is unclear if LC1 and LC2 fractures that are minimally displaced on radiographs obtained shortly after injury benefit from surgical intervention [7,16,20].…”

Section: Introductionmentioning

confidence: 99%

“…Fracture stability might be based on initial displacement of static radiographs, displacement on postmobilization radiographs [5], and/or displacement during an examination under anesthesia [24]. CT evaluation of LC fractures has shown that these represent a spectrum of injuries, and it remains unclear which fractures are covertly unstable [14]. Controversy remains regarding indications for surgical treatment of fractures displaced less than 1 cm on static radiographs.…”

Section: Introductionmentioning

confidence: 99%

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Does Surgical Stabilization of Lateral Compression-type Pelvic Ring Fractures Decrease Patients’ Pain, Reduce Narcotic Use, and Improve Mobilization?

Hagen

Castillo

Dubina

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Debate remains over the role of surgical treatment in minimally displaced lateral compression (Young-Burgess, LC, OTA 61-B1/B2) pelvic ring injuries. Lateral compression type 1 (LC1) injuries are defined by an impaction fracture at the sacrum; type 2 (LC2) are defined by a fracture that extends through the posterior iliac wing at the level of the sacroiliac joint. Some believe that operative stabilization of these fractures limits pain and eases mobilization, but to our knowledge there are few controlled studies on the topic.Questions/purposes (1) Does operative stabilization of LC1 and LC2 pelvic fractures decrease patients' narcotic use and lower their visual analog scale pain scores? (2) Does stabilization allow patients to mobilize earlier with physical therapy? Methods This retrospective study of LC1 and LC2 fractures evaluated patients treated definitively at one institution from 2007 to 2013. All patients treated surgically, all nonoperative LC2, and all nonoperative LC1 fractures with complete sacral injury were included. In general, LC1 or LC2 fractures with greater than 10 mm of displacement and/or sagittal/axial plane deformity on static radiographs were treated surgically. One hundred fiftyeight patients in the LC1 group (107 [of 697 screened] nonoperative, 51 surgical) and 123 patients in the LC2 group (78 nonoperative, 45 surgical) met inclusion criteria. The surgical and nonoperative groups were matched for fracture type. To account for differences between patients treated surgically and nonoperatively, we used propensity modeling techniques incorporating treatment predictors. Propensity scores demonstrated good overlap and were used as part of multiple variable regression models to account for selection bias between the surgically treated and nonoperative groups. Patient-reported pain scores and Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at the University of Maryland, Baltimore, MD, USA. Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® narcotic administration were tallied in 24-hour increments during the first 24 hours of hospitalization, at 48 hours after intervention, and in the 24 hours before discharge. Time from intervention to mobilization out of bed was recorded; intervention was defined as the date of ...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does Surgical Stabilization of Lateral Compression-type Pelvic Ring Fractures Decrease Patients’ Pain, Reduce Narcotic Use, and Improve Mobilization?

Hagen

Castillo

Dubina

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…This emanates from the original work from Young and Burgess who proposed that these injuries are stable based on the fact that the main ligaments contributing to pelvic stability remain intact [4]. However, the association of the anterior fracture of the pelvic ring in conjunction with the variability of the posterior lesion remains poorly understood [5].…”

Section: Introductionmentioning

confidence: 99%

Assessment of Lateral Compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable?

Tosounidis

Kanakaris

Nikolaou

et al. 2012

International Orthopaedics (SICOT)

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Purpose We performed a prospective study to document, by intra-operative manipulation under anaesthesia (MUA) of the pelvic ring, the stability of lateral compression type 1 injuries that were managed in a Level-I Trauma Centre. The documentation of the short-term outcome of the management of these injuries was our secondary aim. Methods A total of 63 patients were included in the study. Thirty-five patients (group A) were treated surgically whereas 28 (group B) were managed nonoperatively. Intraoperative rotational instability, evident by more than two centimetres of translation during the manipulation manoeuvre, was combined with a complete sacral fracture in all cases. Results A statistically significant difference was present between the length of hospital stay, the time to independent painfree mobilisation, post-manipulation pain levels and opioid requirements between the two groups, with group A demonstrating significantly decreased values in all these four variables (p<0.05). There was also a significant difference between the pre-and 72-hour post-manipulation visual analogue scale and analgesic requirements of the group A patients, whereas the patients in group B did not demonstrate such a difference. Conclusion LC-1 injuries with a complete posterior sacral injury are inheritably rotationally unstable and patients presenting with these fracture patterns definitely gain benefit from surgical stabilisation.

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“…These injuries are often related to high-energy trauma and lateral compression fractures [3] are often caused by motor vehicle accidents [20]. Pure lateral compression fractures account for more than 57% of the pelvic fractures [56].…”

Section: Introductionmentioning

confidence: 99%

“…Over the past decade or two, fixation of lateral compression (LC) fractures has been advocated to improve patient comfort and to allow earlier mobilization without loss of reduction, thus minimizing the adverse systemic effects of bed rest [20,44]. Lefaivre et al [24] found that even LC I fractures according to Young and Burgess showed potential instability and complete sacral fractures in 48%.…”

Section: Introductionmentioning

confidence: 99%

Persistent Impairment After Surgically Treated Lateral Compression Pelvic Injury

Hoffmann¹,

Jones

Sietsema

2012

Clinical Orthopaedics &Amp; Related Research

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Background Recently, fixation of lateral compression (LC) pelvic fractures has been advocated to improve patient comfort and to allow earlier mobilization without loss of reduction, thus minimizing adverse systemic effects. However, the degree of acceptable deformity and persistence of disability are unclear. Questions/purposes We determined if (1) injury pattern; (2) demographics; (3) final posterior displacement; (4) L5/ S1 involvement; (5) associated injuries; and (6) time influence outcome measurements, sexual dysfunction, and pain.

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Lateral compression fracture of the pelvis represents a heterogeneous group of complex 3D patterns of displacement

Cited by 48 publications

References 13 publications

Does Surgical Stabilization of Lateral Compression-type Pelvic Ring Fractures Decrease Patients’ Pain, Reduce Narcotic Use, and Improve Mobilization?

Does Surgical Stabilization of Lateral Compression-type Pelvic Ring Fractures Decrease Patients’ Pain, Reduce Narcotic Use, and Improve Mobilization?

Assessment of Lateral Compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable?

Persistent Impairment After Surgically Treated Lateral Compression Pelvic Injury

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