Unilateral Sacral Fractures Demonstrate Slow Recovery of Patient-Reported Outcomes Irrespective of Treatment

Abstract

Patients/Participants: Skeletally mature patients with unilateral zone 1 or 2 sacral fractures categorized as displaced nonoperative (DN), displaced operative (DO), nondisplaced nonoperative (NN), and nondisplaced operative (NO).Main Outcome Measurements: Pelvic displacement was documented on injury plain radiographs. Short Musculoskeletal Function Assessment (SMFA) scores were obtained at baseline and at 3, 6, 12, and 24 months after injury. Displacement was defined as greater than 5 mm in any plane at the time of injury.Results: Two hundred eighty-six patients with unilateral sacral fractures were initially enrolled, with a mean age of 40 years and mean injury severity score of 16. One hundred twenty-three patients completed the 2-year follow-up as follows: 29 DN, 30 DO, 47 NN, and 17 NO with 56% loss to follow-up at 2 years. Highest dysfunction was seen at 3 months for all groups with mean SMFA dysfunction scores: 25 DN, 28 DO, 27 NN, and 31 NO. The mean SMFA scores at 2 years for all groups were 13 DN, 12 DO, 17 NN, and 17 NO.Conclusions: All groups (operative/nonoperative and displaced/ nondisplaced) reported worst function 3 months after injury, and all but (DN) continued to recover for 2 years after injury, with peak recovery for DN seen at 1 year. No functional benefit was seen with operative intervention for either displaced or nondisplaced injuries at any time point.

Combined Anterior–Posterior versus Posterior-Only Fixation of Stress-Positive Minimally Displaced Lateral Compression Type 1 (LC1) Pelvic Ring Injuries

“…Nonoperative management for minimally displaced LC1 injuries is well supported in the literature, especially surrounding long-term functional and radiographic outcomes. [13][14][15][17][18][19][20]26 However, much of the data in these studies incorporates the entire spectrum of LC1 injuries and does not isolate the early outcomes of patients with dynamic instability on EUA or stress examinations. 9,27,28 It has been demonstrated in multiple studies that operative management in appropriately selected patients, seems to improve the early outcomes of stress positive patients in pain and mobility.…”

“…2,[7][8][9][10][11][12][13] However, it has been repeatedly shown that the long-term outcomes of these injuries are similar, regardless of operative management. [13][14][15][16][17][18][19][20] Percutaneous screw fixation of the posterior ring followed by repeat stress examination to determine the necessity of anterior ring fixation has been previously demonstrated to be a successful management strategy in preventing late fracture displacement. 11,12 Because the main proposed benefit of fixation is believed to be an improved early recovery, a strategy that maximizes pelvis stability may be more beneficial.…”

“…2,7–13 However, it has been repeatedly shown that the long-term outcomes of these injuries are similar, regardless of operative management. 13–20…”

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

“…[1][2][3][4][5][6] Although nonoperative management has demonstrated long-term success in multiple studies, others have shown improvement in early outcomes of mobilization, pain control, and hospital length of stay with operative management of unstable minimally displaced LC1 injuries. 2,[7][8][9][10][11][12][13][14][15][16][17][18][19] To better identify patients who may benefit from surgical fixation, many studies have investigated injury patterns and characteristics suggestive of instability. 2,10,[20][21][22][23] In addition, examination under anesthesia (EUA) and stress radiographs have been used in evaluation of patients with minimally displaced injuries to determine the degree of dynamic displacement present to identify patients who may benefit from operative management.…”

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

“…ateral compression type 1 (LC-1) pelvic ring injuries account for more than 60% of all pelvic ring injuries and most demonstrate minimal displacement and may be treated nonsurgically with predictable outcome. [1][2][3][4][5][6][7][8][9][10] The practice of obtaining plain radiographs after mobilization from bed has been widely used to assess for fracture displacement, which may warrant alteration of the proposed treatment plan. 11 However, clear…”