Prevalence of Pelvic Fractures, Associated Injuries, and Mortality: The United Kingdom Perspective

Giannoudis, Peter V.; Grotz, M.; Tzioupis, C.; Dinopoulos, Haralambos; Wells, Gareth E; Bouamra, Otmar; Lecky, Fiona

doi:10.1097/01.ta.0000242259.67486.15

Cited by 217 publications

(193 citation statements)

References 48 publications

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“…Stable pelvic injuries rarely result in major long-term problems [8,21] because their initial treatment is mostly straightforward and their recovery uneventful and complete [49,53]. In contrast, patients with unstable pelvic ring disruptions are considerably more challenging to treat, and limited ambulation and incomplete recovery reportedly range from 25% to 73% [35,44,49,53,64,65,70].…”

Section: Introductionmentioning

confidence: 99%

“…They are lethal in 3% to 30% of cases and are associated with a high incidence of concomitant morbidity [3,13,15,21,27,48,52]. During the past decade, with enhanced understanding of the physiologic response to trauma and advances made in diagnostics, critical care medicine, and acute trauma management [5,23,26,57], an increased number (81%-90%) of injured patients with severe pelvic injuries survive [26,29,58].…”

Section: Introductionmentioning

confidence: 99%

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Treatment and Outcomes of Pelvic Malunions and Nonunions: A Systematic Review

Kanakaris

Angoules

Nikolaou

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Although acute management of pelvic fractures and their long-term functional outcome have been widely documented, important information regarding malunion and nonunion of these fractures is sparse. Despite their relative rarity, malunions and nonunions cause disabling symptoms and have major socioeconomic implications. We analyzed the factors predisposing a pelvic injury to develop malunion/nonunion, the clinical presentation of these complications, and the efficacy of the reported operative protocols in 437 malunions/nonunions of 25 clinical studies. Treatment of these demanding complications appeared effective in the majority of the cases: overall union rates averaged 86.1%, pain relief as much as 93%, patient satisfaction 79%, and return to a preinjury level of activities 50%. Nevertheless, the patient should be informed about the incidence of perioperative complications, including neurologic injury (5

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment and Outcomes of Pelvic Malunions and Nonunions: A Systematic Review

Kanakaris

Angoules

Nikolaou

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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“…This injury reportedly is associated with an increase in mortality rates from 15% to 35%, when associated with multiple injuries [2,8,19,20]. The major sources of bleeding are assumed to be the presacral and retroperitoneal veins [30], sacral arterial disruptions [24], or cancellous bone surfaces [24].…”

Section: Introductionmentioning

confidence: 99%

Can a Modified Anterior External Fixator Provide Posterior Compression of AP Compression Type III Pelvic Injuries?

Sellei

Schandelmaier

Kobbe

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Current anterior fixators can close a disrupted anterior pelvic ring. However, these anterior constructs cannot create posterior compressive forces across the sacroiliac joint. We explored whether a modified fixator could create such forces. Questions/purposes We determined whether (1) an anterior external fixator with a second anterior articulation (X-frame) would provide posterior pelvic compression and (2) full pin insertion would deliver higher posterior compressive forces than half pin insertion. Methods We simulated AP compression Type III instability with plastic pelvis models and tested the following conditions: (1) single-pin supraacetabular external fixator (SAEF) using half pin insertion (60 mm); (2) SAEF using full pin insertion (120 mm); (3) modified fixator with X-frame using half pin insertion; (4) modified fixator using full pin insertion; and (5) C-clamp. Standardized fracture compression in the anterior and posterior compartment was performed as in previous studies by Gardner. A forcesensitive sensor was placed in the symphysis and posterior pelvic ring before fracture reduction and the fractures were reduced. The symphyseal and sacroiliac compression loads of each application were measured. Results The SAEF exerted mean compressions of 13 N and 14 N to the posterior pelvic ring using half and full pin insertions, respectively. The modified fixator had mean posterior compressions of 174 N and 222 N with half and full pin insertions, respectively. C-clamp application exerted a mean posterior load of 407 N. Conclusions Posterior compression on the pelvis was improved using an X-frame as an anterior fixation device in a synthetic pelvic fracture model. Clinical Relevance This additive device may improve the initial anterior and posterior stability in the acute management of unstable and life-threatening pelvic ring injuries.

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“…In the latter, these injuries are usually the result of high-energy trauma [1], whereas in the former group these are mostly low-energy injuries, secondary to falls, or repeated stresses to osteopenic/ osteoporotic bone, the so-called Bfragility pelvic fractures( FPFs) [2]. Noteworthy, in terms of hospital admissions FPFs are as common as the high-energy pelvic fractures [3], and when compared to fragility hip fractures the ratio is equal to 1:5.…”

Section: Introductionmentioning

confidence: 99%

Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: can service improvement be expected?

Kanakaris

Greven

West

et al. 2017

International Orthopaedics (SICOT)

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Purpose The incidence of low energy pelvic fractures (FPFs) in the elderly is increasing. Comorbidities, decreased bonequality, problematic fracture fixation and poor compliance represent some of their specific difficulties. In the absence of uniform management, a standard operating procedure (SOP) was introduced to our unit, aiming to improve the quality of services provided to these patients. Methods A cohort study was contacted to test the impact of (1) using a specific clinical algorithm and (2) using different antiosteoporotic drugs. Multivariate regression analysis was used to determine prognostic factors. Study endpoints were the time-to-healing, length-of-stay, return to pre-injury mobility, union status, mortality and complications. Results A total of 132 elderly patients (≥65 years) admitted during the period 2012-2014 with FPFs were enrolled. Highenergy fractures, acetabular fractures, associated trauma affecting mobility, pathological pelvic lesions and operated FPFs were used as exclusion criteria. The majority of included patients were females (108/132; 81.8%), and the mean age was 85.8 years (range 67-108). Use of antiosteoporotics was associated with a shorter time of healing (p = 0.036). Patients treated according to the algorithm showed a significant protection against malunion (p < 0.001). Also, adherence to the algorithm allowed more patients to return to their pre-injury mobility status (p = 0.039). Conclusions The use of antiosteoporotic medication in elderly patients with fragility pelvic fractures was associated with faster healing, whilst the adherence to a structured clinical pathway led to less malunions and non-unions and return to pre-injury mobility state.

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Prevalence of Pelvic Fractures, Associated Injuries, and Mortality: The United Kingdom Perspective

Abstract: Age, early physiologic derangement, and presence of other injuries (head or trunk) were associated with reduced survival rates. When the expertise to deal with such a group of patients is not available, early transfer under safe conditions should be considered to improve survival rates.

Cited by 217 publications

References 48 publications

Treatment and Outcomes of Pelvic Malunions and Nonunions: A Systematic Review

Treatment and Outcomes of Pelvic Malunions and Nonunions: A Systematic Review

Can a Modified Anterior External Fixator Provide Posterior Compression of AP Compression Type III Pelvic Injuries?

Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: can service improvement be expected?

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