The German Multicentre Pelvis Registry: A template for an European Expert Network?
Introduction
Pelvic fractures are rare injuries when compared to fractures occurring in other body regions. Also the range of severity of the injury is wide and includes simple, undisplaced pelvic fractures, which may only limit the activity of the individual patient for a short period of time, as well as severe, complex or even open pelvic fractures, causing immediate life threatening situations. Even with continuous progress in the development of techniques and treatment protocols, primary treatment and definitive reconstruction of pelvic ring injuries and acetabular fractures, there is still an ongoing debate about specific problems in the evaluation of injuries and fractures, the indications for operative stabilisation and optimal surgical techniques. Based on the relatively low incidence of 19–37 pelvic fractures/100,000 inhabitants and year,8 the individual experience, which can be acquired by the surgical team, even in major Trauma Centres is limited and can only be acquired over a longer period of time. These deficits can be observed in many studies which include either too few cases to be suitable for valid statistical evaluation, or long observation periods with inevitable changes in surgical strategy, which also lead to methodological difficulties. In Germany, after the completion of a focused multicentre study, sponsored by the German Section of AO, the need for a systematic, continuous multicentre approach for valid scientific analysis of pelvic injuries became evident in the late 1980s.
The German Multicentre Study Group I became active and the Sponsorship of the German section of AO International and later of the German Trauma Society (DGU) on 1 January in 1991 and included 10 University- and Major Trauma Hospitals. With several modifications and expansion of the number of participating hospitals, the Group has remained active and is just entering a “third phase” converting into the “German Multicentre Pelvic and Acetabular Registry” an Internet based data registry.b By the use of Internet technology a unique working tool is now available, which allows easy access and on site data entry. Under protection of state of the art safety standards, the access to study files is easy and even enables sequential data acquisition, when Internet access is provided in the patent's location (Emergency Room, Intensive Care Unit, Regular Ward, Operating Room). As this registry is already designed as an open platform, not limited in capacity and regions, it provides a platform, which may easily be expanded to a European level allowing for international multicentre studies and case sampling.
The purpose of this paper is to describe the experience and the evolution during 15 years of work with this study group and to give a view of how this registry could become the backbone of an European network of excellence in pelvic and acetabular surgery.
Section snippets
German Pelvis Multicentre Study Group I (German Section of AO International and German Trauma Society)
After a short inaugural phase in 1990 the German Multicentre Pelvis Study Group became active on 1 January 1991. It included 10 University Hospitals and Regional Trauma Centres.c
Epidemiology
Pelvic fractures show a clear two peak incidence in general. The first peak is around the high activity level of 18 to 25–35 years. The majority of cases results from high energy injuries in motorcycle or car accidents. A second peak over 70 years has a clear focus on the female population and mostly represents fractures related to the decrease in bone stock and quality, and are caused by low energy trauma. The peak around the 50s only visible in the male population cannot clearly be explained
Discussion
Pelvic fractures still remain a challenge to the treating physician.1, 2, 4, 5, 9 The incidence of these injuries is relatively rare, but on some occasions life threatening injuries demand rapid decision making and treatment. The available studies, even when dealing with a high number of patients, are associated with the disadvantages of a longitudinal study. Therefore they lack comparability when cases are collected over time periods of 10 or even more years. The use of a multicentre approach
Acknowledgements
German Multicentre Study I was supported by an AO Grant (Project Number 94-T27), the German Multicentre Pelvic Study Group II + III by the German Trauma Society (DGU) and the Norddeutsche Landesbank, Braunschweig.
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Pelvic ring fractures in the elderly now and then – a pelvic registry study
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On behalf of the German Multicentre Study Group (German Trauma Society/German AO).