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Published in: International Orthopaedics 12/2012

01-12-2012 | Original Paper

Assessment of Lateral Compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable?

Authors: Theodoros Tosounidis, Nikolaos Kanakaris, Vasilios Nikolaou, Boon Tan, Peter V. Giannoudis

Published in: International Orthopaedics | Issue 12/2012

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Abstract

Purpose

We performed a prospective study to document, by intra-operative manipulation under anaesthesia (MUA) of the pelvic ring, the stability of lateral compression type 1 injuries that were managed in a Level-I Trauma Centre. The documentation of the short-term outcome of the management of these injuries was our secondary aim.

Methods

A total of 63 patients were included in the study. Thirty-five patients (group A) were treated surgically whereas 28 (group B) were managed nonoperatively. Intraoperative rotational instability, evident by more than two centimetres of translation during the manipulation manoeuvre, was combined with a complete sacral fracture in all cases.

Results

A statistically significant difference was present between the length of hospital stay, the time to independent pain-free mobilisation, post-manipulation pain levels and opioid requirements between the two groups, with group A demonstrating significantly decreased values in all these four variables (p < 0.05). There was also a significant difference between the pre- and 72-hour post-manipulation visual analogue scale and analgesic requirements of the group A patients, whereas the patients in group B did not demonstrate such a difference.

Conclusion

LC-1 injuries with a complete posterior sacral injury are inheritably rotationally unstable and patients presenting with these fracture patterns definitely gain benefit from surgical stabilisation.
Literature
1.
go back to reference Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS Jr, Poka A, Bathon GH, Brumback RJ (1990) Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 30(7):848–856PubMedCrossRef Burgess AR, Eastridge BJ, Young JW, Ellison TS, Ellison PS Jr, Poka A, Bathon GH, Brumback RJ (1990) Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 30(7):848–856PubMedCrossRef
2.
go back to reference Manson T, O’Toole RV, Whitney A, Duggan B, Sciadini M, Nascone J (2010) Young-Burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? J Orthop Trauma 24(10):603–609. doi:10.1097/BOT.0b013e3181d3cb6b PubMedCrossRef Manson T, O’Toole RV, Whitney A, Duggan B, Sciadini M, Nascone J (2010) Young-Burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? J Orthop Trauma 24(10):603–609. doi:10.​1097/​BOT.​0b013e3181d3cb6b​ PubMedCrossRef
4.
go back to reference Young JW, Burgess AR, Brumback RJ, Poka A (1986) Pelvic fractures: value of plain radiography in early assessment and management. Radiology 160(2):445–451PubMed Young JW, Burgess AR, Brumback RJ, Poka A (1986) Pelvic fractures: value of plain radiography in early assessment and management. Radiology 160(2):445–451PubMed
6.
go back to reference Lefaivre KA, Padalecki JR, Starr AJ (2009) 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 23(1):16–21. doi:10.1097/BOT.0b013e31818f8a81 PubMedCrossRef Lefaivre KA, Padalecki JR, Starr AJ (2009) 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 23(1):16–21. doi:10.​1097/​BOT.​0b013e31818f8a81​ PubMedCrossRef
9.
go back to reference Denis F, Davis S, Comfort T (1988) Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 227:67–81PubMed Denis F, Davis S, Comfort T (1988) Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 227:67–81PubMed
11.
go back to reference Lau TW, Leung F (2010) Occult posterior pelvic ring fractures in elderly patients with osteoporotic pubic rami fractures. J Orthop Surg (Hong Kong) 18(2):153–157 Lau TW, Leung F (2010) Occult posterior pelvic ring fractures in elderly patients with osteoporotic pubic rami fractures. J Orthop Surg (Hong Kong) 18(2):153–157
13.
go back to reference Gordon RO, Mears DC (1991) Lateral compression injury of the pelvis. A case report. J Bone Joint Surg Am 73(9):1399–1401PubMed Gordon RO, Mears DC (1991) Lateral compression injury of the pelvis. A case report. J Bone Joint Surg Am 73(9):1399–1401PubMed
14.
go back to reference Routt ML Jr, Simonian PT, Ballmer F (1995) A rational approach to pelvic trauma. Resuscitation and early definitive stabilization. Clin Orthop Relat Res 318:61–74PubMed Routt ML Jr, Simonian PT, Ballmer F (1995) A rational approach to pelvic trauma. Resuscitation and early definitive stabilization. Clin Orthop Relat Res 318:61–74PubMed
15.
go back to reference Tile M (1980) Pelvic fractures: operative versus nonoperative treatment. Orthop Clin N Am 11(3):423–464 Tile M (1980) Pelvic fractures: operative versus nonoperative treatment. Orthop Clin N Am 11(3):423–464
16.
go back to reference Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 70(1):1–12PubMed Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 70(1):1–12PubMed
17.
go back to reference Miranda MA, Riemer BL, Butterfield SL, Burke CJ 3rd (1996) Pelvic ring injuries. A long term functional outcome study. Clin Orthop Relat Res 329:152–159PubMedCrossRef Miranda MA, Riemer BL, Butterfield SL, Burke CJ 3rd (1996) Pelvic ring injuries. A long term functional outcome study. Clin Orthop Relat Res 329:152–159PubMedCrossRef
20.
go back to reference Bellabarba C, Ricci WM, Bolhofner BR (2000) Distraction external fixation in lateral compression pelvic fractures. J Orthop Trauma 14(7):475–482PubMedCrossRef Bellabarba C, Ricci WM, Bolhofner BR (2000) Distraction external fixation in lateral compression pelvic fractures. J Orthop Trauma 14(7):475–482PubMedCrossRef
22.
go back to reference Sembler Soles GL, Lien J, Tornetta P 3rd (2012) Nonoperative immediate weightbearing of minimally displaced lateral compression sacral fractures does not result in displacement. J Orthop Trauma 26(10):563–567. doi:10.1097/BOT.0b013e318251217b Sembler Soles GL, Lien J, Tornetta P 3rd (2012) Nonoperative immediate weightbearing of minimally displaced lateral compression sacral fractures does not result in displacement. J Orthop Trauma 26(10):563–567. doi:10.​1097/​BOT.​0b013e318251217b​
24.
26.
go back to reference Hoffmann MF, Jones CB, Sietsema DL (2012) Persistent impairment after surgically treated lateral compression pelvic injury. Clin Orthop Relat Res 470(8):2161–2172. doi:10.1007/s11999-012-2247-1 Hoffmann MF, Jones CB, Sietsema DL (2012) Persistent impairment after surgically treated lateral compression pelvic injury. Clin Orthop Relat Res 470(8):2161–2172. doi:10.​1007/​s11999-012-2247-1
Metadata
Title
Assessment of Lateral Compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable?
Authors
Theodoros Tosounidis
Nikolaos Kanakaris
Vasilios Nikolaou
Boon Tan
Peter V. Giannoudis
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
International Orthopaedics / Issue 12/2012
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-012-1685-4

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