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

Abstract

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.

Early Outcomes of Operative Versus Nonoperative Management of Stress-Positive Minimally Displaced Lateral Compression Type 1 Pelvic Ring Injuries

“…[24][25][26][27] If operative management in geriatric patients is able to improve mobility and avoid SAR placement, then it may beneficial for patients and the medical system from a financial perspective. 24,28 However, the low number of geriatric patients (n = 17) in this study limits any meaningful conclusion regarding such benefits.…”

Pelvic Ring Injuries: Stable or Not?

“…This resulted in increased rates of surgical management, increased rates of physical therapy clearance, and a lower percentage of patients needing to discharge to rehabilitation facilities. 44 In 2022, DeKeyser et al published a different instability detection protocol that is done on the awake patient while in the emergency department. The protocol is an abridged Sagi examination that involves a series of three 40°inlet radiographs starting with a static view with the lower extremities internally rotated.…”

“…This resulted in increased rates of surgical management, increased rates of physical therapy clearance, and a lower percentage of patients needing to discharge to rehabilitation facilities. 44…”