Moving forward with the management of minimally displaced lateral compression pelvic ring injuries

Parry, Joshua A.; Tucker, Nicholas J

doi:10.1007/s00590-022-03303-1

Cited by 9 publications

(10 citation statements)

References 11 publications

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“…Future studies must address these limitations with a prospective, randomized design that focuses specifically on the shortterm and long-term effects of operative versus nonoperative management for patients with LC injuries that have dynamic displacement .1 cm as determined by standardized calibrated measurements. 29,31,41 Overall, implementation of an LSR protocol to determine management of minimally displaced stresspositive LC1 injuries was associated with increased operative management, increased rates of PT clearance, and a reduction in the number of patients discharging to rehabilitation facilities. Further research is required to determine the effect that the LSR protocol has on posthospital outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Operative Management of Stress-Positive Minimally Displaced Lateral Compression Type 1 (LC1) Pelvic Ring Injuries: Analysis of Outcomes Before and After Implementation of a Departmental Stress Protocol

Tucker

Scott

Heare

et al. 2023

Journal of Orthopaedic Trauma

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Objectives: To compare the hospital course of patients with minimally displaced (,1 cm) lateral compression type 1 injuries treated before and after implementation of lateral stress radiographs (LSRs) to determine management.Design: Retrospective comparative cohort.Setting: Urban level 1 trauma center.Patients/Participants: Isolated lateral compression type 1 injuries managed before (n = 33) and after implementation of LSRs (n = 40) to determine management.Intervention: Patients in a prestress cohort managed nonoperatively versus patients in an LSR cohort managed operatively if stress positive ($1 cm displacement on LSRs).Main Outcome Measurements: Physical therapy clearance before discharge, discharge location, hospital length of stay, and inpatient opioid morphine milligram equivalents were measured. Results:The prestress and LSR protocol groups were similar in demographic/injury characteristics (age, sex, mechanism, American Society of Anesthesiologists score, Nakatani classification, bilateral/ unilateral injury, Denis zone, sacral fracture completeness, and sacral comminution). Forty-five percent of LSR protocol patients were stress-positive (n = 18) and managed operatively. The LSR protocol group was more likely to clear physical therapy by discharge (97.5% vs. 75.8%, PD: 21.7%, 95% CI: 5.1%-36.8%, P = 0.009), less likely to discharge to a rehabilitation facility (2.5% vs. 18.2%, PD: 215.7%, CI: 230.0% to 20.5%, P = 0.04), and had no difference in length of stay (MD: 0.0, CI:-1.0 to 1.0, P = 0.57) or inpatient opioid morphine milligram equivalents (MD: 9.0, CI: 260.0 to 101.0, P = 0.71). Conclusion:Implementation of an LSR protocol to determine management of minimally displaced stress-positive lateral compression type 1 injuries was associated with increased rates of operative management, physical therapy clearance by discharge, and a reduction in the number of patients discharging to rehabilitation facilities.

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Section: Discussionmentioning

confidence: 99%

“…Future studies must address these limitations with a prospective, randomized design that focuses specifically on the short-term and long-term effects of operative versus nonoperative management for patients with LC injuries that have dynamic displacement >1 cm as determined by standardized calibrated measurements. 29,31,41…”

Section: Discussionmentioning

confidence: 99%

Operative Management of Stress-Positive Minimally Displaced Lateral Compression Type 1 (LC1) Pelvic Ring Injuries: Analysis of Outcomes Before and After Implementation of a Departmental Stress Protocol

Tucker

Scott

Heare

et al. 2023

Journal of Orthopaedic Trauma

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“…It is possible that patients with LC-1 injuries and a planned nonsurgical course will have difficulty mobilizing from bed. 4,8,[23][24][25] In such cases surgery has been proposed to provide stability and thus to afford pain relief and to improve mobility from bed. 5,11,19,23,26 Progressing to surgery without obtaining postmobilization radiography is a reasonable option, although some patients may elect to continue with a nonsurgical treatment plan.…”

Section: Discussionmentioning

confidence: 99%

Postmobilization Plain Radiography After Lateral Compression Type 1 Pelvic Ring Injury Does Not Affect Treatment

Brostowitz,

Heimke,

Furdock

et al. 2023

JAAOS Glob Res Rev

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Introduction: The purpose of this study was to describe the practice of postmobilization radiography after lateral compression type 1 pelvis ring injury. We hypothesized that postmobilization radiographs would be more frequent over time and would not influence treatment. Methods: Displacement of pelvis ring injury on initial and final plain radiographs was measured. Frequency of postmobilization radiography was determined, and the impact on treatment and final radiographical outcome were assessed. Results: Of the 156 patients reviewed, 98 (62.8%) were women and mean age was 60.1 years. Thirty-three of 156 patients (21.2%) had a postmobilization radiograph. Over 5 years, radiographs increased to 67% of presenting patients. None of the patients who received postmobilization plain radiographs (n = 33) had any change in clinical plan afterward; all continued with nonsurgical care. Initial fracture characteristics and alignment were no different for patients with postmobilization radiographs. Final alignment was unchanged in nearly 70%. Overall, 74% of all nonsurgical patients experienced no change in alignment, with similar rates among the patients with postmobilization radiographs. Discussion: Patients with an lateral compression type 1 fracture demonstrated no changes in care after receiving postmobilization radiographs. However, the frequency of postmobilization radiographs increased over time, denoting opportunities to reduce costs and to improve efficiency and safety.

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“…2 For these reasons, some authors argue for altering management of stress-positive minimally displaced LC injuries to improve the early recovery process of these patients. [3][4][5] In frail geriatric patients, this strategy may be even more warranted to avoid prolonged bed rest and its subsequent complications.…”

Section: Introductionmentioning

confidence: 99%

Geriatric Patients Presenting With Isolated Pubic Rami Fractures and Inability to Mobilize May Have Occult Lateral Compression Pelvic Ring Injuries With Dynamic Instability

Tucker

Scott

Mauffrey

et al. 2023

Journal of Orthopaedic Trauma

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Moving forward with the management of minimally displaced lateral compression pelvic ring injuries

Cited by 9 publications

References 11 publications

Operative Management of Stress-Positive Minimally Displaced Lateral Compression Type 1 (LC1) Pelvic Ring Injuries: Analysis of Outcomes Before and After Implementation of a Departmental Stress Protocol

Operative Management of Stress-Positive Minimally Displaced Lateral Compression Type 1 (LC1) Pelvic Ring Injuries: Analysis of Outcomes Before and After Implementation of a Departmental Stress Protocol

Postmobilization Plain Radiography After Lateral Compression Type 1 Pelvic Ring Injury Does Not Affect Treatment

Geriatric Patients Presenting With Isolated Pubic Rami Fractures and Inability to Mobilize May Have Occult Lateral Compression Pelvic Ring Injuries With Dynamic Instability

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