Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 8/2012

01-08-2012 | Symposium: Disruptions of the Pelvic Ring: An Update

Persistent Impairment After Surgically Treated Lateral Compression Pelvic Injury

Authors: Martin F. Hoffmann, MD, Clifford B. Jones, MD, Debra L. Sietsema, RN, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 8/2012

Login to get access

Abstract

Background

Recently, fixation of lateral compression (LC) pelvic fractures has been advocated to improve patient comfort and to allow earlier mobilization without loss of reduction, thus minimizing adverse systemic effects. However, the degree of acceptable deformity and persistence of disability are unclear.

Questions/purposes

We determined if (1) injury pattern; (2) demographics; (3) final posterior displacement; (4) L5/S1 involvement; (5) associated injuries; and (6) time influence outcome measurements, sexual dysfunction, and pain.

Methods

We retrospectively reviewed 119 patients with unstable LC injuries treated surgically between 2000 and 2010. There were 52 males and 67 females; mean age was 39 years with a mean body mass index of 27 kg/m2. All patients underwent clinical examination and radiographic imaging for instability and accompanying injuries. We obtained Short Musculoskeletal Function Assessment (SMFA). The minimum followup was 12 months (mean, 33 months; range, 12–100 months).

Results

SMFA subscores were not affected by injury pattern and demographics. Posterior reduction was less than 5 mm with persistent displacement in 99 of 119 (83%). Displacement of 5 to 10 mm did not affect any SMFA subscore at any time interval. Patients with additional lower extremity injuries had worse SMFA scores. Function improved with time. A visual analog scale pain score of 4 or more at 6 months predicted pain and overall SMFA score at last followup.

Conclusions

Unstable LC pelvic ring injuries result in persistent disability based on validated outcome measurements. Near anatomical reduction can be achieved and maintained. While our findings need to be confirmed in studies with high rates of followup, patients with unstable LC pelvic injuries should be counseled concerning the possibility of some degree of persistent disability.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
Bellabarba C, Ricci WM, Bolhofner BR. Distraction external fixation in lateral compression pelvic fractures. J Orthop Trauma. 2000;14:475–482.PubMedCrossRef
2.
Bruce B, Reilly M, Sims S. OTA Highlight paper predicting future displacement of nonoperatively managed lateral compression sacral fractures: can it be done? J Orthop Trauma. 2011;25:523–527.PubMedCrossRef
3.
Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS Jr, Poka A, Bathon GH, Brumback RJ. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma. 1990;30:848–856.PubMedCrossRef
4.
Chip Routt MLJ, Simonian PT, Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma. 1997;11:584–589.CrossRef
5.
Cole JD, Blum DA, Ansel LJ. Outcome after fixation of unstable posterior pelvic ring injuries. Clin Orthop Relat Res. 1996;329:160–179.PubMedCrossRef
6.
Copeland CE, Bosse MJ, McCarthy ML, MacKenzie EJ, Guzinski GM, Hash CS, Burgess AR. Effect of trauma and pelvic fracture on female genitourinary, sexual, and reproductive function. J Orthop Trauma. 1997;11:73–81.PubMedCrossRef
7.
Dechert TA, Duane TM, Frykberg BP, Aboutanos MB, Malhotra AK, Ivatury RR. Elderly patients with pelvic fracture: interventions and outcomes. Am Surg. 2009;75:291–295.PubMed
8.
Dujardin FH, Hossenbaccus M, Duparc F, Biga N, Thomine JM. Long-term functional prognosis of posterior injuries in high-energy pelvic disruption. J Orthop Trauma. 1998;12:145–150; discussion 150–151.PubMedCrossRef
9.
Durkin A, Sagi HC, Durham R, Flint L. Contemporary management of pelvic fractures. Am J Surg. 2006;192:211–223.PubMedCrossRef
10.
Genuario J, Koval KJ, Cantu RV, Spratt KF. Does hospital surgical volume affect in-hospital outcomes in surgically treated pelvic and acetabular fractures? Bull NYU Hosp Jt Dis. 2008;66:282–289.PubMed
11.
Giannoudis PV, Tzioupis CC, Pape HC, Roberts CS. Percutaneous fixation of the pelvic ring: an update. J Bone Joint Surg Br. 2007;89:145–154.PubMedCrossRef
12.
Goldstein A, Phillips T, Sclafani SJ, Scalea T, Duncan A, Goldstein J, Panetta T, Shaftan G. Early open reduction and internal fixation of the disrupted pelvic ring. J Trauma. 1986;26:325–333.PubMedCrossRef
13.
Griffin DR, Starr AJ, Reinert CM, Jones AL, Whitlock S. Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? J Orthop Trauma. 2003;17:399–405.PubMedCrossRef
14.
Gruen GS, Leit ME, Gruen RJ, Garrison HG, Auble TE, Peitzman AB. Functional outcome of patients with unstable pelvic ring fractures stabilized with open reduction and internal fixation. J Trauma. 1995;39:838–844: discussion 844–845.PubMedCrossRef
15.
Guthrie HC, Owens RW, Bircher MD. Fractures of the pelvis. J Bone Joint Surg Br. 2010;92:1481–1488.PubMedCrossRef
16.
Harwood PJ, Grotz M, Eardley I, Giannoudis PV. Erectile dysfunction after fracture of the pelvis. J Bone Joint Surg Br. 2005;87:281–290.PubMedCrossRef
17.
Henderson RC. The long-term results of nonoperatively treated major pelvic disruptions. J Orthop Trauma. 1989;3:41–47.PubMedCrossRef
18.
Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population. J Bone Joint Surg Am. 2002;84:208–215.PubMed
19.
20.
Khoury A, Kreder H, Skrinskas T, Hardisty M, Tile M, Whyne CM. Lateral compression fracture of the pelvis represents a heterogeneous group of complex 3D patterns of displacement. Injury. 2008;39:893–902.PubMedCrossRef
21.
King J. Impotence after fractures of the pelvis. J Bone Joint Surg Am. 1975;57:1107–1109.PubMed
22.
Krappinger D, Larndorfer R, Struve P, Rosenberger R, Arora R, Blauth M. Minimally invasive transiliac plate osteosynthesis for type C injuries of the pelvic ring: a clinical and radiological follow-up. J Orthop Trauma. 2007;21:595–602.PubMedCrossRef
23.
Latenser BA, Gentilello LM, Tarver AA, Thalgott JS, Batdorf JW. Improved outcome with early fixation of skeletally unstable pelvic fractures. J Trauma. 1991;31:28–31.PubMedCrossRef
24.
Lefaivre KA, Padalecki JR, Starr AJ. What constitutes a Young and Burgess lateral compression-I (OTA 61-B2) pelvic ring disruption? A description of computed tomography-based fracture anatomy and associated injuries. J Orthop Trauma. 2009;23:16–21.PubMedCrossRef
25.
26.
Lindahl J, Hirvensalo E. Outcome of operatively treated type-C injuries of the pelvic ring. Acta Orthop. 2005;76:667–678.PubMedCrossRef
27.
Machtens S, Gansslen A, Pohlemann T, Stief CG. Erectile dysfunction in relation to traumatic pelvic injuries or pelvic fractures. BJU Int. 2001;87:441–448.PubMedCrossRef
28.
Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg Br. 1989;71:304–306.PubMed
29.
Majeed SA. External fixation of the injured pelvis. The functional outcome. J Bone Joint Surg Br. 1990;72:612–614.PubMed
30.
Matta JM, Tornetta P 3rd. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res. 1996;329:129–140.PubMedCrossRef
31.
McCarthy ML, MacKenzie EJ, Bosse MJ, Copeland CE, Hash CS, Burgess AR. Functional status following orthopedic trauma in young women. J Trauma. 1995;39:828–836: discussion 836–837.PubMedCrossRef
32.
Mehta S, Auerbach JD, Born CT, Chin KR. Sacral fractures. J Am Acad Orthop Surg. 2006;14:656–665.PubMed
33.
Miranda MA, Riemer BL, Butterfield SL, Burke CJ 3rd. Pelvic ring injuries. A long term functional outcome study. Clin Orthop Relat Res. 1996;329:152–159.PubMedCrossRef
34.
Mullis BH, Sagi HC. Minimum 1-year follow-up for patients with vertical shear sacroiliac joint dislocations treated with iliosacral screws: does joint ankylosis or anatomic reduction contribute to functional outcome? J Orthop Trauma. 2008;22:293–298.PubMedCrossRef
35.
Oliver CW, Twaddle B, Agel J, Routt ML Jr. Outcome after pelvic ring fractures: evaluation using the medical outcomes Short Form SF-36. Injury. 1996;27:635–641.PubMedCrossRef
36.
Olson SA, Pollak AN. Assessment of pelvic ring stability after injury. Indications for surgical stabilization. Clin Orthop Relat Res. 1996;329:15–27.PubMedCrossRef
37.
Oransky M, Tortora M. Nonunions and malunions after pelvic fractures: why they occur and what can be done? Injury. 2007;38:489–496.PubMedCrossRef
38.
Papakostidis C, Kanakaris NK, Kontakis G, Giannoudis PV. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop. 2009;33:329–338.PubMedCrossRef
39.
Pennal GF, Tile M, Waddell JP, Garside H. Pelvic disruption: assessment and classification. Clin Orthop Relat Res. 1980;151:12–21.PubMed
40.
Pohlemann T, Gansslen A, Schellwald O, Culemann U, Tscherne H. [Outcome evaluation after unstable injuries of the pelvic ring] [in German]. Der Unfallchirurg. 1996;99:249–259.PubMedCrossRef
41.
Powers ML, Hatem SF, Sundaram M. Morel-Lavallee lesion. Orthopedics. 2007;30:250, 322–353.
42.
Rommens PM, Hessmann MH. Staged reconstruction of pelvic ring disruption: differences in morbidity, mortality, radiologic results, and functional outcomes between B1, B2/B3, and C-type lesions. J Orthop Trauma. 2002;16:92–98.PubMedCrossRef
43.
Routt ML Jr, Falicov A, Woodhouse E, Schildhauer TA. Circumferential pelvic antishock sheeting: a temporary resuscitation aid. J Orthop Trauma. 2002;16:45–48.PubMedCrossRef
44.
Routt ML Jr, Kregor PJ, Simonian PT, Mayo KA. Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma. 1995;9:207–214.PubMedCrossRef
45.
Sems SA, Johnson M, Cole PA, Byrd CT, Templeman DC. Elevated body mass index increases early complications of surgical treatment of pelvic ring injuries. J Orthop Trauma. 2010;24:309–314.PubMedCrossRef
46.
Suzuki T, Shindo M, Soma K, Minehara H, Nakamura K, Uchino M, Itoman M. Long-term functional outcome after unstable pelvic ring fracture. J Trauma. 2007;63:884–888.PubMedCrossRef
47.
Swiontkowski MF, Engelberg R, Martin DP, Agel J. Short musculoskeletal function assessment questionnaire: validity, reliability, and responsiveness. J Bone Joint Surg Am. 1999;81:1245–1260.PubMedCrossRef
48.
Templeman D, Goulet J, Duwelius PJ, Olson S, Davidson M. Internal fixation of displaced fractures of the sacrum. Clin Orthop Relat Res. 1996;329:180–185.PubMedCrossRef
49.
Templeman DC, Simpson T, Matta JM. Surgical management of pelvic ring injuries. Instr Course Lect. 2005;54:395–400.PubMed
50.
Tile M. Fractures of the Pelvis and Acetabulum. Baltimore, MD, USA: Lippincott Williams & Wilkins; 1984.
51.
Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br. 1988;70:1–12.PubMed
52.
Tornetta P 3rd, Dickson K, Matta JM. Outcome of rotationally unstable pelvic ring injuries treated operatively. Clin Orthop Relat Res. 1996;329:147–151.PubMedCrossRef
53.
Totterman A, Glott T, Soberg HL, Madsen JE, Roise O. Pelvic trauma with displaced sacral fractures: functional outcome at one year. Spine. 2007;32:1437–1443.PubMedCrossRef
54.
Vallier HA, Cureton BA, Ekstein C, Oldenburg FP, Wilber JH. Early definitive stabilization of unstable pelvis and acetabulum fractures reduces morbidity. J Trauma. 2010;69:677–684.PubMedCrossRef
55.
Van den Bosch EW, Van der Kleyn R, Hogervorst M, Van Vugt AB. Functional outcome of internal fixation for pelvic ring fractures. J Trauma. 1999;47:365–371.PubMedCrossRef
56.
Young JW, Burgess AR, Brumback RJ, Poka A. Lateral compression fractures of the pelvis: the importance of plain radiographs in the diagnosis and surgical management. Skeletal Radiol. 1986;15:103–109.PubMedCrossRef
57.
Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment. Radiology. 1986;160:445–451.PubMed
58.
Young JW, Resnik CS. Fracture of the pelvis: current concepts of classification. AJR. Am J Roentgenol. 1990;155:1169–1175.PubMed
Metadata
Title
Persistent Impairment After Surgically Treated Lateral Compression Pelvic Injury
Authors
Martin F. Hoffmann, MD
Clifford B. Jones, MD
Debra L. Sietsema, RN, PhD
Publication date
01-08-2012
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 8/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2247-1

Other articles of this Issue 8/2012

Clinical Orthopaedics and Related Research® 8/2012 Go to the issue

Symposium: Disruptions of the Pelvic Ring: An Update

Complications of Anterior Subcutaneous Internal Fixation for Unstable Pelvis Fractures: A Multicenter Study

Symposium: Disruptions of the Pelvic Ring: An Update

The Classic: Dislocation and Fracture-Dislocation of the Pelvis

Basic Research

Anti-TGF-β Antibody Combined with Dendritic Cells Produce Antitumor Effects in Osteosarcoma

Clinical Research

MRI is Unnecessary for Diagnosing Acute Achilles Tendon Ruptures: Clinical Diagnostic Criteria

Clinical Research

Does Landmark Selection Affect the Reliability of Tibial Tubercle–Trochlear Groove Measurements Using MRI?

Clinical Research

Reason for Revision Influences Early Patient Outcomes After Aseptic Knee Revision