Nonoperative Management of Minimally Displaced Lateral Compression Type 1 Pelvic Ring Injuries With and Without Occult Instability

Abstract

Objectives:To determine the association of pelvic fracture displacement on lateral stress radiographs (LSRs) with the hospital course of patients with minimally displaced lateral compression type 1 (LC1) pelvic injuries.Design:Retrospective review.Setting:Level 1 trauma center.Patients/Participants:Twenty-eight adult patients with minimally displaced (<1 cm) LC1 injuries.Intervention:Nonoperative management.Main Outcome Measurements:Delayed operative fixation, days to clear physical therapy, mobilization, hospital length of stay, and total hospital opioid morphine equivalent dose.Results:LSR displacement was correlated with delayed operative fixation [r = 0.23, 95% confidence interval (CI) 0.05–1.11; P = 0.01], days to clear PT (r = 0.13, CI 0.01–0.28; P = 0.02), length of stay (r = 0.13, CI 0.006–0.26; P = 0.02), and opioid morphine equivalent dose (r = 19.4, CI 1.5–38.1; P = 0.03). A receiver operating characteristic curve for delayed operative fixation over LSR displacement had an area under the curve of 0.87. The LSR displacement threshold that maximized sensitivity and specificity for detecting patients who required delayed fixation was 10 mm (100% sensitivity and 78% specificity). Ten of the 15 patients with ≥10 mm of displacement on LSRs underwent delayed operative fixation for pain with mobilization at a median of 6 days (interquartile range 3.7–7.5). Patients with ≥10 mm of displacement on LSRs took longer to clear PT, took longer to walk 15 feet, had longer hospital stays, and used more opioids.Conclusions:LC1 fracture displacement on LSRs is associated with delayed operative fixation, difficulty mobilizing secondary to pain, longer hospital stays, and opioid use.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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

“…Fifteen of these patients had $10 mm of displacement on LSR and took longer to clear PT, had longer hospital stays, and used more inpatient opioids then those patients who displaced ,10 mm. 13 In addition, 10 of the 15 patients with $10 mm †Post hoc testing revealed significant differences between Nakatani type I (PD, 224.8%, CI, 243.1% to 24.5%, P = 0.02) and Nakatani type III (PD, 23.2%, CI, 5.9%-38.5%, P = 0.008). These did not affect the significance of multivariate analysis.…”

“…Fifteen of these patients had ≥10 mm of displacement on LSR and took longer to clear PT, had longer hospital stays, and used more inpatient opioids then those patients who displaced <10 mm. 13 In addition, 10 of the 15 patients with ≥10 mm of displacement on LSR converted to operative management at a median of 6 days (3.7–7.5) because of limited mobility secondary to pain. 13 In another study by the same group, 40 patients with isolated LC1 injuries were age- and sex-matched with 40 patients with isolated intertrochanteric fractures.…”

“…13 In addition, 10 of the 15 patients with ≥10 mm of displacement on LSR converted to operative management at a median of 6 days (3.7–7.5) because of limited mobility secondary to pain. 13 In another study by the same group, 40 patients with isolated LC1 injuries were age- and sex-matched with 40 patients with isolated intertrochanteric fractures. 14 Patients with displacement on LSR took longer to clear physical therapy, had longer hospital stays, and required more opioids; a hospital course that did not differ from the patients with intertrochanteric femur fractures.…”

“…The major argument for operative management of LC1 injuries with displacement on stress radiographs is early improvement in pain and mobilization. 13,14 Parry et al 13 analyzed the outcomes of 28 patients with isolated LC1 injuries managed nonoperatively. Fifteen of these patients had $10 mm of displacement on LSR and took longer to clear PT, had longer hospital stays, and used more inpatient opioids then those patients who displaced ,10 mm.…”

“…Referencing prior studies investigating the degree of displacement on stress radiographs, patients were categorized into groups with dynamic displacement of ,10 and $10 mm on the LSR. 10,11,[13][14][15] All measurements were made by a fellowship-trained orthopaedic trauma surgeon.…”