Skip to main content
Erschienen 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?

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

Erschienen in: International Orthopaedics | Ausgabe 12/2012

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat 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.
Zurück zum Zitat 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.
Zurück zum Zitat 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.
Zurück zum Zitat 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.
Zurück zum Zitat 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.
Zurück zum Zitat 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.
Zurück zum Zitat 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.
Zurück zum Zitat 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.
Zurück zum Zitat 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.
Zurück zum Zitat 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.
Zurück zum Zitat 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.
Zurück zum Zitat 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.
Zurück zum Zitat 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.
Zurück zum Zitat Suzuki T, Morgan SJ, Smith WR, Stahel PF, Flierl MA, Hak DJ (2010) Stress radiograph to detect true extent of symphyseal disruption in presumed anteroposterior compression type I pelvic injuries. J Trauma 69(4):880–885. doi:10.1097/TA.0b013e3181efbad5 PubMedCrossRef Suzuki T, Morgan SJ, Smith WR, Stahel PF, Flierl MA, Hak DJ (2010) Stress radiograph to detect true extent of symphyseal disruption in presumed anteroposterior compression type I pelvic injuries. J Trauma 69(4):880–885. doi:10.​1097/​TA.​0b013e3181efbad5​ PubMedCrossRef
26.
Zurück zum Zitat 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
Metadaten
Titel
Assessment of Lateral Compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable?
verfasst von
Theodoros Tosounidis
Nikolaos Kanakaris
Vasilios Nikolaou
Boon Tan
Peter V. Giannoudis
Publikationsdatum
01.12.2012
Verlag
Springer-Verlag
Erschienen in
International Orthopaedics / Ausgabe 12/2012
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-012-1685-4

Weitere Artikel der Ausgabe 12/2012

International Orthopaedics 12/2012 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.