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01-12-2020 | Acetabular Fracture | Research article

Associated abdominal injuries do not influence quality of care in pelvic fractures—a multicenter cohort study from the German Pelvic Registry

Authors: Markus A. Küper, Robert Bachmann, Götz F. Wenig, Patrick Ziegler, Alexander Trulson, Inga M. Trulson, Christian Minarski, Ruth Ladurner, Ulrich Stöckle, Andreas Höch, Steven C. Herath, Fabian M. Stuby, Working Group on Pelvic Fractures of the German Trauma Society

Published in: World Journal of Emergency Surgery | Issue 1/2020

Abstract

Background

Pelvic fractures are rare but serious injuries. The influence of a concomitant abdominal trauma on the time point of surgery and the quality of care regarding quality of reduction or the clinical course in pelvic injuries has not been investigated yet.

Methods

We retrospectively analyzed the prospective consecutive cohort from the multicenter German Pelvic Registry of the German Trauma Society in the years 2003–2017. Demographic, clinical, and operative parameters were recorded and compared for two groups (isolated pelvic fracture vs. combined abdominal/pelvic trauma).

Results

16.359 patients with pelvic injuries were treated during this period. 21.6% had a concomitant abdominal trauma. The mean age was 61.4 ± 23.5 years. Comparing the two groups, patients with a combination of pelvic and abdominal trauma were significantly younger (47.3 ± 22.0 vs. 70.5 ± 20.4 years; p < 0.001). Both, complication (21.9% vs. 9.9%; p < 0.001) and mortality (8.0% vs. 1.9%; p < 0.001) rates, were significantly higher.

In the subgroup of acetabular fractures, the operation time was significantly longer in the group with the combined injury (198 ± 104 vs. 176 ± 81 min, p = 0.001). The grade of successful anatomic reduction of the acetabular fracture did not differ between the two groups.

Conclusion

Patients with a pelvic injury have a concomitant abdominal trauma in about 20% of the cases. The clinical course is significantly prolonged in patients with a combined injury, with increased rates of morbidity and mortality. However, the quality of the reduction in the subgroup of acetabular fractures is not influenced by a concomitant abdominal injury.

Trial registration

ClinicalTrials.gov, NCT03952026, Registered 16 May 2019, retrospectively registered

Andrich S, Haastert B, Neuhaus E, et al. Epidemiology of pelvic fractures in Germany: considerably high incidence rates among older people. PLoS One. 2015;10:e0139078.CrossRef

Hauschild O, Strohm PC, Culemann U, et al. Mortality in patients with pelvic fractures: results from the German pelvic injury register. J Trauma. 2008;64:449–55.CrossRef

Arvieux C, Thony F, Broux C, et al. Current management of severe pelvic and perineal trauma. J Visc Surg. 2012;149:e227–38.CrossRef

Gad MA, Saber A, Farrag S, et al. Incidence, patterns, and factors predicting mortality of abdominal injuries in trauma patients. N Am J Med Sci. 2012;4:129–34.CrossRef

Ferrah N, Cameron P, Gabbe B, et al. Trends in the nature and management of serious abdominal trauma. World J Surg. 2019;43:1216–25.CrossRef

Lee CH, Hsu CC, Huang PY. Biomechanical study of different fixation techniques for the treatment of sacroiliac joint injuries using finite element analyses and biomechanical tests. Comput Biol Med. 2017;87:250–7.CrossRef

Giráldez-Sánchez MA, Lázaro-Gonzálvez Á, Martínez-Reina J, et al. Percutaneous iliosacral fixation in external rotational pelvic fractures. A biomechanical analysis. Injury. 2015;46:327–32.CrossRef

Rommens PM, Wagner D, Hofmann A. Minimal invasive surgical treatment of fragility fractures of the pelvis. Chirurgia (Bucur). 2017;112:524–37.CrossRef

Madhu R, Kotnis R, Al-Mousawi A, et al. Outcome of surgery for reconstruction of fractures of the acetabulum. The time dependent effect of delay. J Bone Joint Surg Br. 2006;88:1197–203.CrossRef

10.

Matta JM, Mehne DK, Roffi R. Fractures of the acetabulum. Early results of a prospective study. Clin Orthop Relat Res. 1986;205:241–50.

11.

Rollmann MF, Holstein JH, Pohlemann T, et al. Predictors for secondary hip osteoarthritis after acetabular fractures-a pelvic registry study. Int Orthop. 2019;43:2167–73.CrossRef

12.

Swaid F, Peleg K, Alfici R, et al. A comparison study of pelvic fractures and associated abdominal injuries between pediatric and adult blunt trauma patients. J Pediatr Surg. 2017;52:386–9.CrossRef

13.

Phruetthiphat OA, Willey M, Karam MD, et al. Comparison of outcomes and complications of isolated acetabular fractures and acetabular fractures with associated injuries. J Orthop Trauma. 2017;31:31–6.CrossRef

14.

Navarro S, Montmany S, Rebasa P, et al. Impact of ATLS training on preventable and potentially preventable deaths. World J Surg. 2014;38:2273–8.CrossRef

15.

Weber DG, Bendinelli C, Balogh ZJ. Damage control surgery for abdominal emergencies. Br J Surg. 2014;101:e109–18.CrossRef

16.

D'Alleyrand JC, O'Toole RV. The evolution of damage control orthopedics: current evidence and practical applications of early appropriate care. Orthop Clin North Am. 2013;44:499–507.CrossRef

17.

Holstein JH, Stuby FM, Herath SC, et al. Influence of the pelvic trauma registry of the DGU on treatment of pelvic ring fractures. Unfallchirurg. 2016;119:475–81.CrossRef

18.

Coccolini F, Stahel PF, Montori G, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017;12:5.CrossRef

19.

Katsoulis E, Giannoudis PV. Impact of timing of pelvic fixation on functional outcome. Injury. 2006;37:1133–42.CrossRef

20.

Blackmore CC, Jurkovich GJ, Linnau KF, et al. Assessment of volume of hemorrhage and outcome from pelvic fracture. Arch Surg. 2003;138:504–9.CrossRef

21.

Gaski IA, Barckman J, Naess PA, et al. Reduced need for extraperitoneal pelvic packing for severe pelvic fractures is associated with improved resuscitation strategies. J Trauma Acute Care Surg. 2016;81:644–51.CrossRef

22.

Holstein JH, Culemann U, Pohlemann T. What are predictors of mortality in patients with pelvic fractures? Clin Orthop Relat Res. 2012;470:2090–7.CrossRef

23.

Black SR, Sathy AK, Jo C, et al. Improved Survival after pelvic fracture: 13-year experience at a single trauma center using a multidisciplinary institutional protocol. J Orthop Trauma. 2016;30:22–8.CrossRef

24.

Borgman MA, Spinella PC, Perkins JG, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63:805–13.CrossRef

25.

Holcomb JB, Wade CE, Michalek JE, et al. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg. 2008;248:447–58.PubMed

26.

Holcomb JB, Tilley BC, Baraniuk S, et al. A transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313:471–82.CrossRef

27.

Schweigkofler U, Wohlrath B, Trentsch H, et al. Diagnostics and early treatment in prehospital and emergency-room phase in suspicious pelvic ring fractures. Eur J Trauma Emerg Surg. 2018;44:747–52.CrossRef

28.

Eastridge BJ, Starr A, Minei JP, et al. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma. 2002;53:446–51.CrossRef

29.

Marzi I, Lustenberger T. Management of bleeding pelvic fractures. Scand J Surg. 2014;103:104–11.CrossRef

30.

Niola R, Pinto A, Sparano A, et al. Arterial bleeding in pelvic trauma: priorities in angiographic embolization. Curr Probl Diagn Radiol. 2012;41:93–101.CrossRef

31.

Perkins ZB, Maytham GD, Koers L, et al. Impact on outcome of a targeted performance improvement programme in haemodynamically unstable patients with a pelvic fracture. Bone Joint J. 2014;96-B:1090–7.CrossRef

32.

White CE, Hsu JR, Holcomb JB. Haemodynamically unstable pelvic fractures. Injury. 2009;40:1023–30.CrossRef

33.

Vallier HA, Cureton BA, Ekstein C, et al. Early definitive stabilization of unstable pelvis and acetabulum fractures reduces morbidity. J Trauma. 2010;69:677–84.CrossRef

34.

Vallier HA, Dolenc AJ, Moore TA. Early appropriate care: a protocol to standardize resuscitation assessment and to expedite fracture care reduces hospital stay and enhances revenue. J Orthop Trauma. 2016;30:306–11.PubMed

35.

Glass NE, Burlew CC, Hahnhaussen J, et al. Early definitive fracture fixation is safely performed in the presence of an open abdomen in multiply injured patients. J Orthop Trauma. 2017;31:624–30.CrossRef

36.

Demetriades D, Karaiskakis M, Velmahos GC, et al. Pelvic fractures in pediatric and adult trauma patients: are they different injuries? J Trauma. 2003;54:1146–51.CrossRef

37.

Demetriades D, Karaiskakis M, Toutouzas C, et al. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg. 2002;195:1–10.CrossRef

38.

Chawda MN, Hildebrand F, Pape HC, et al. Predicting outcome after multiple trauma: which scoring system? Injury. 2004;35:347–58.CrossRef

Title: Associated abdominal injuries do not influence quality of care in pelvic fractures—a multicenter cohort study from the German Pelvic Registry
Authors: Markus A. Küper
Robert Bachmann
Götz F. Wenig
Patrick Ziegler
Alexander Trulson
Inga M. Trulson
Christian Minarski
Ruth Ladurner
Ulrich Stöckle
Andreas Höch
Steven C. Herath
Fabian M. Stuby
Working Group on Pelvic Fractures of the German Trauma Society
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Acetabular Fracture
Care
Abdominal Trauma
Pelvic Trauma
Published in: World Journal of Emergency Surgery / Issue 1/2020
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-020-0290-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Associated abdominal injuries do not influence quality of care in pelvic fractures—a multicenter cohort study from the German Pelvic Registry

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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