Validated Radiographic Scoring System for Lateral Compression Type 1 Pelvis Fractures

Beckmann, James T.; Haller, Justin M.; Beebe, Michael J.; Ali, Amanda; Presson, Angela P.; Stuart, Ami; Sagi, H. Claude; Kubiak, Erik N.

doi:10.1097/bot.0000000000001639

Cited by 24 publications

(38 citation statements)

References 22 publications

(25 reference statements)

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“…Thus, a close follow-up especially for non-operatively treated cases is necessary. Additional factors such as general health 21 and a radiographic rating system 37 may help with decision-making, especially for FFP II.…”

Section: Discussionmentioning

confidence: 99%

A computed tomography based survey study investigating the agreement of the therapeutic strategy for fragility fractures of the pelvis

Pieroh

Hohmann

Gras

et al. 2022

Sci Rep

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Treatment recommendations for fragility fractures of the pelvis (FFP) have been provided along with the good reliable FFP classification but they are not proven in large studies and recent reports challenge these recommendations. Thus, we aimed to determine the usefulness of the FFP classification determining the treatment strategy and favored procedures in six level 1 trauma centers. Sixty cases of FFP were evaluated by six experienced pelvic surgeons, six inexperienced surgeons in training, and one surgeon trained by the originator of the FFP classification during three repeating sessions using computed tomography scans with multiplanar reconstruction. The intra-rater reliability and inter-rater reliability for therapeutic decisions (non-operative treatment vs. operative treatment) were moderate, with Fleiss kappa coefficients of 0.54 (95% confidence interval [CI] 0.44–0.62) and 0.42 (95% CI 0.34–0.49). We found a therapeutic disagreement predominantly for FFP II related to a preferred operative therapy for FFP II. Operative treated cases were generally treated with an anterior–posterior fixation. Despite the consensus on an anterior–posterior fixation, the chosen procedures are highly variable and most plausible based on the surgeon’s preference.

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Section: Discussionmentioning

confidence: 99%

A computed tomography based survey study investigating the agreement of the therapeutic strategy for fragility fractures of the pelvis

Pieroh

Hohmann

Gras

et al. 2022

Sci Rep

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“…Even though, there is a proposed scoring system was in predicting nonoperative or operative treatment, based on radiographic fracture characteristics of the sacrum, inferior ramus, and superior ramus [ 17 ]. Individual characteristic on the initial static X-ray and CT scan images of LC-1 pelvis vary greatly, and it is difficult to distinguish stability in imaging data.…”

Section: Discussionmentioning

confidence: 99%

The traditional experience strategy (TES) and combined ultrasonography examination (CUE) for the treatment of lateral compression type 1 pelvic fractures: a historical control study

Huang

Zhang

Liu

et al. 2021

BMC Musculoskelet Disord

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Background It is difficult to judge the stability of lateral compression type-1 (LC-1) pelvic fracture, as it is often based on static images of the pelvis. Compared with the traditional experience strategy, ultrasonography examination may be able to distinguish operative and conservative patients before definitive treatment. However, in previous studies, we have not compared the outcomes between traditional experience strategy (TES group) and combined ultrasonography examination (CUE group). Thus, the aim of the study is comparing the differences between TES and CUE strategy, to identify the value of ultrasonography examination. Methods Medical records system for patients with LC-1 pelvic fractures who were treated with TES and CUE strategy were included. Patients’ baseline characteristics, treatment strategy, and function were recorded at follow-up. Functional outcomes were evaluated using the Majeed grading system. Results In total, 77 patients with LC-1 pelvic fractures were included in the study. There were 42 and 35 patients in TES and CUE group, respectively. Compared to TES group (69 %), there were less proportion patients chosen the operative treatment in CUE group (43 %, P = 0.021). The volume of intraoperative blood loss in CUE operative group was more than TES operative group (P = 0.037). There were more patients with complete sacral fracture in CUE operative group than TES operative group (P = 0.002). The Majeed scores in CUE conservative group was higher than TES conservative group (P = 0.008). The overall Majeed scores in CUE group was higher than that in TES group (P = 0.039). Conclusions The ultrasonography examination could relatively accurately identify the unstable LC-1 pelvis than the traditional experience strategy, the operative rate could be reduced and the overall function of LC-1 patients could be improved under the ultrasonography examination. Level of evidence Level III.

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“…20,25,26,30,31,47 Improved modern imaging has also seen the development of radiological systems for assessing severity of pelvic fractures, but despite this an integrated and validated pelvic and sacral classification system remains lacking. 32…”

Section: Historical Classification Systems-pelvic Ring Fracture Class...mentioning

confidence: 99%

“…[21][22][23]25,26,47,48 Similarly, sacral classification systems either are entirely focused on a particular sacral fracture morphology, such as those proposed by Denis et al or by Roy-Camille et al, or address only an isolated portion of the sacrum, such as the lumbosacral junction system of Isler. 32,[39][40][41] An ideal classification is rationally structured in its introduction of fracture patterns and addresses both mechanical stability and neurological status, as well as being reproducible with high interrater reliability. 46,49,50 We aimed to review all historical classification systems and to demonstrate the value of the pioneering AO Spine Sacral and Pelvic Classification System in comparison.…”

mentioning

confidence: 99%

Evolution of the AO Spine Sacral and Pelvic Classification System: a systematic review

Kweh

Tee

Öner

et al. 2022

Journal of Neurosurgery: Spine

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OBJECTIVE The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading systems. METHODS A systematic search of MEDLINE, EMBASE, Google Scholar, and Cochrane databases was performed consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all existing sacral and pelvic fracture classification systems. RESULTS A total of 49 articles were included in this review, comprising 23 pelvic classification systems and 17 sacral grading schemes. The AO Spine Sacral and Pelvic Classification System represents both the evolutionary product of these historical systems and a reinvention of classic concepts in 5 ways. First, the classification introduces fracture types in a graduated order of biomechanical stability while also taking into consideration the neurological status of patients. Second, the traditional belief that Denis central zone III fractures have the highest rate of neurological deficit is not supported because this subgroup often includes a broad spectrum of injuries ranging from a benign sagittally oriented undisplaced fracture to an unstable “U-type” fracture. Third, the 1990 Isler lumbosacral system is adopted in its original format to divide injuries based on their likelihood of affecting posterior pelvic or spinopelvic stability. Fourth, new discrete fracture subtypes are introduced and the importance of bilateral injuries is acknowledged. Last, this is the first integrated sacral and pelvic classification to date. CONCLUSIONS The AO Spine Sacral and Pelvic Classification is a universally applicable system that redefines and reorders historical fracture morphologies into a rational hierarchy. This is the first classification to simultaneously address the biomechanical stability of the posterior pelvic complex and spinopelvic stability, while also taking into consideration neurological status. Further high-quality controlled trials are required prior to the inclusion of this novel classification within a validated scoring system to guide the management of sacral and pelvic injuries.

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Validated Radiographic Scoring System for Lateral Compression Type 1 Pelvis Fractures

Cited by 24 publications

References 22 publications

A computed tomography based survey study investigating the agreement of the therapeutic strategy for fragility fractures of the pelvis

A computed tomography based survey study investigating the agreement of the therapeutic strategy for fragility fractures of the pelvis

The traditional experience strategy (TES) and combined ultrasonography examination (CUE) for the treatment of lateral compression type 1 pelvic fractures: a historical control study

Evolution of the AO Spine Sacral and Pelvic Classification System: a systematic review

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