nach oben

European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

05.08.2023 | Original Article

Nonoperative management of minimally displaced lateral compression type 1 (LC1) injuries with comminuted rami fractures is associated with late displacement

verfasst von: Nicholas J. Tucker, Bryan L. Scott, Austin Heare, Stephen C. Stacey, Cyril Mauffrey, Joshua A. Parry

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 7/2024

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Rami comminution has been found to be predictive of lateral compression type 1 (LC1) injury instability on examination under anesthesia (EUA) and lateral stress radiographs (LSR). The purpose of this study was to evaluate how rami comminution and subsequent operative vs. nonoperative management impact the late displacement of these injuries.

Methods

Retrospective review of a prospectively collected LC1 database was performed to identify all patients with minimally displaced LC1 injuries (< 1 cm) and follow-up radiographs over a four-year period (n = 125). Groups were separated based on the presence of rami comminution and subsequent management, including rami comminution/operative (n = 49), rami comminution/nonoperative (n = 54), and no comminution/nonoperative (control group, n = 22). The primary outcome was late fracture displacement, analyzed as both a continuous variable and as late displacement ≥ 5 mm.

Results

As a continuous variable, late fracture displacement was lower in the comminuted rami/operative group as compared to the comminuted rami/nonoperative group (PD: −3.0 mm, CI: −4.8 to −1.6 mm, p = 0.0002) and statistically non-different from control. Late displacement ≥ 5 mm was significantly more prevalent in the comminuted rami/nonoperative group than in the comminuted rami/operative and no comminution/nonoperative groups (control)(PD: −33.9%, CI: −49.0% to −16.1%, p = 0.0002 and PD: −30.0%, CI: −48.2% to −6.5%, p = 0.02, respectively).

Conclusion

Late fracture displacement was greatest in the group with rami comminution/nonoperative management. Rami comminution, which has been previously associated with dynamic displacement on EUA and LSR, is also associated with a higher incidence of late displacement when managed nonoperatively.

Level of evidence

Level III, prognostic retrospective cohort study.

Parry JA, Tucker NJ (2022) Moving forward with the management of minimally displaced lateral compression pelvic ring injuries. Eur J Orthop Surg Traumatol 32:1223–1224. https://doi.org/10.1007/S00590-022-03303-1CrossRefPubMed

Manson T, O’Toole R, Whitney A et al (2010) Young-Burgess classification of pelvic ring fractures: does it predict mortality, transfusion requirements, and non-orthopaedic injuries? J Orthop Trauma 24:603–608. https://doi.org/10.1097/BOT.0B013E3181D3CB6BCrossRefPubMed

Tosounidis T, Kanakaris N, Nikolaou V et al (2012) Assessment of Lateral Compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable? Int Orthop 36:2553–2558. https://doi.org/10.1007/S00264-012-1685-4CrossRefPubMedPubMedCentral

Kuršumović K, Hadeed M, Bassett J et al (2021) Lateral compression type 1 (LC1) pelvic ring injuries: a spectrum of fracture types and treatment algorithms. Eur J Orthop Surg Traumatol 31:841–854. https://doi.org/10.1007/S00590-021-02935-ZCrossRefPubMed

Beckmann J, Presson A, Curtis S et al (2014) Operative agreement on lateral compression-1 pelvis fractures. a survey of 111 OTA members. J Orthop Trauma 28:681–685. https://doi.org/10.1097/BOT.0000000000000133CrossRefPubMed

Carney JJ, Nguyen A, Alluri RK et al (2020) A survey to assess agreement between pelvic surgeons on the outcome of examination under anesthesia for lateral compression pelvic fractures. J Orthop Trauma 34:E304–E308. https://doi.org/10.1097/BOT.0000000000001759CrossRefPubMed

Parry J, Funk A, Heare A et al (2020) An international survey of pelvic trauma surgeons on the management of pelvic ring injuries. Injury 52:2685–2692. https://doi.org/10.1016/J.INJURY.2020.07.027CrossRefPubMed

Barei D, Shafer B, Beingessner D et al (2010) The impact of open reduction internal fixation on acute pain management in unstable pelvic ring injuries. J Trauma 68:949–953. https://doi.org/10.1097/TA.0B013E3181AF69BECrossRefPubMed

Sagi H, Coniglione F, Stanford J (2011) Examination under anesthetic for occult pelvic ring instability. J Orthop Trauma 25:529–536. https://doi.org/10.1097/BOT.0B013E31822B02AECrossRefPubMed

10.

Parry JA, Hadeed MM, Tucker NJ et al (2022) Nonoperative management of minimally displaced lateral compression type 1 pelvic ring injuries with and without occult instability. J Orthop Trauma 36:287–291. https://doi.org/10.1097/BOT.0000000000002300CrossRefPubMed

11.

Tucker NJ, Mauffrey C, Parry JA (2022) Unstable minimally displaced lateral compression type 1 (LC1) pelvic ring injuries have a similar hospital course as intertrochanteric femur fractures. Injury 53:481–487. https://doi.org/10.1016/J.INJURY.2021.12.002CrossRefPubMed

12.

Tucker NJ, Heare A, Stacey SC et al (2023) The lateral stress radiograph: an effective alternative to examination under anesthesia for identifying occult instability in minimally displaced lateral compression pelvic ring injuries. Eur J Orthop Surg Traumatol 33:1965–1971. https://doi.org/10.1007/s00590-022-03373-1CrossRefPubMed

13.

Tucker NJ, Scott BL, Heare A et al (2023) Combined anterior-posterior versus posterior-only fixation of stress-positive minimally displaced lateral compression type 1 (LC1) pelvic ring injuries. J Orthop Trauma 37:189–194. https://doi.org/10.1097/BOT.0000000000002519CrossRefPubMed

14.

Avilucea FR, Archdeacon MT, Collinge CA et al (2018) Fixation strategy using sequential intraoperative examination under anesthesia for unstable lateral compression pelvic ring injuries reliably predicts union with minimal displacement. J Bone Joint Surg Am 100:1503–1508. https://doi.org/10.2106/JBJS.17.01650CrossRefPubMed

15.

DeKeyser GJ, Kellam PJ, Haller JM et al (2022) Emergency department stress radiographs of lateral compression type-1 pelvic ring injuries are safe, effective, and reliable. J Bone Joint Surg Am 104:336–344. https://doi.org/10.2106/JBJS.21.00737CrossRefPubMed

16.

Slobogean GP, Gaski GE, Nascone J et al (2021) A prospective clinical trial comparing surgical fixation versus nonoperative management of minimally displaced complete lateral compression pelvis fractures. J Orthop Trauma 35:592–598. https://doi.org/10.1097/BOT.0000000000002088CrossRefPubMed

17.

Sembler Soles G, Lien J, Tornetta P (2012) Nonoperative immediate weightbearing of minimally displaced lateral compression sacral fractures does not result in displacement. J Orthop Trauma 26:563–567. https://doi.org/10.1097/BOT.0B013E318251217BCrossRefPubMed

18.

Bruce B, Reilly M, Sims S (2011) OTA highlight paper predicting future displacement of nonoperatively managed lateral compression sacral fractures: can it be done? J Orthop Trauma 25:523–527. https://doi.org/10.1097/BOT.0B013E3181F8BE33CrossRefPubMed

19.

Soni A, Gupta R, Kapoor L, Vashisht S (2020) Functional outcome of ‘LC-1 pelvic ring injury with incomplete sacral fracture’ managed non-operatively. J Clin Orthop Trauma 11:S1. https://doi.org/10.1016/J.JCOT.2019.09.013CrossRefPubMed

20.

Gaski G, Manson T, Castillo R et al (2014) Nonoperative treatment of intermediate severity lateral compression type 1 pelvic ring injuries with minimally displaced complete sacral fracture. J Orthop Trauma 28:674–680. https://doi.org/10.1097/BOT.0000000000000130CrossRefPubMed

21.

Vallier H, Lowe J, Agel J et al (2019) Surgery for unilateral sacral fractures: are the indications clear? J Orthop Trauma 33:619–625. https://doi.org/10.1097/BOT.0000000000001587CrossRefPubMed

22.

Mullis BH, Agel J, Jones C et al (2022) Unilateral sacral fractures demonstrate slow recovery of patient-reported outcomes irrespective of treatment. J Orthop Trauma 36:179–183. https://doi.org/10.1097/BOT.0000000000002260CrossRefPubMed

23.

Marenghi N, Bang KE, Danelson K et al (2022) Contributions of pubic rami fracture morphology and fixation to pelvic ring stability in type 1 lateral compression injuries: a biomechanical cadaveric study. J Orthop Trauma 36:S7–S11. https://doi.org/10.1097/BOT.0000000000002306CrossRefPubMed

24.

Khoury A, Kreder H, Skrinskas T et al (2008) Lateral compression fracture of the pelvis represents a heterogeneous group of complex 3D patterns of displacement. Injury 39:893–902. https://doi.org/10.1016/J.INJURY.2007.09.017CrossRefPubMed

25.

Zhang BF, Wang J, Zhang YM et al (2021) The morphological mapping of lateral compression type 1 pelvic fracture and pelvic ring stability classification: a finite element analysis. J Orthop Surg Res 16:1–10. https://doi.org/10.1186/S13018-021-02818-3/FIGURES/8CrossRef

26.

Beckmann J, Haller JM, Beebe M et al (2020) Validated radiographic scoring system for lateral compression type 1 pelvis fractures. J Orthop Trauma 34:70–76. https://doi.org/10.1097/BOT.0000000000001639CrossRefPubMedPubMedCentral

27.

Hadeed MM, Tucker NJ, Heare A et al (2022) Rami comminution is associated with displacement of minimally displaced lateral compression type 1 (LC1) injuries on lateral stress radiographs. J Orthop Trauma 36:489–493. https://doi.org/10.1097/BOT.0000000000002403CrossRefPubMed

28.

Ellis JD, Shah NS, Archdeacon MT, Sagi HC (2022) Anterior pelvic ring fracture pattern predicts subsequent displacement in lateral compression sacral fractures. J Orthop Trauma 36:550–556. https://doi.org/10.1097/BOT.0000000000002407CrossRefPubMed

29.

Parry J, Salameh M, Maher M et al (2020) The lateral stress radiograph identifies occult instability of lateral compression pelvic ring injuries without sedation. J Orthop Trauma 34:567–571. https://doi.org/10.1097/BOT.0000000000001805CrossRefPubMed

30.

Parry JA, Hadeed MM, Strage KE et al (2022) Lateral stress radiographs (LSR) of lateral compression type 1 (LC1) pelvic injuries, with the injured-side down or up, reliably measures occult instability. J Orthop Trauma 36:494–497. https://doi.org/10.1097/BOT.0000000000002374CrossRefPubMed

31.

Tucker NJ, Scott BL, Heare A et al (2023) The effect of pelvic ring rotation and tilt on the radiographic teardrop distance: an important consideration in the assessment of dynamic displacement on stress radiographs. Eur J Orthop Surg Traumatol 33:1953–1957. https://doi.org/10.1007/s00590-022-03377-xCrossRefPubMed

32.

Tucker NJ, Scott BL, Heare A et al (2023) Operative management of stress-positive minimally displaced lateral compression type 1 (LC1) pelvic ring injuries: analysis of outcomes before and after implementation of a departmental stress protocol. J Orthop Trauma 37:263–269. https://doi.org/10.1097/BOT.0000000000002567CrossRefPubMed

33.

Tucker NJ, Scott BL, Heare A et al (2023) Early outcomes of operative versus nonoperative management of stress-positive minimally displaced lateral compression type 1 (LC1) pelvic ring injuries. J Orthop Trauma. https://doi.org/10.1097/BOT.0000000000002642CrossRefPubMed

34.

Dekeyser GJ, Kellam PJ, Higgins TF et al (2023) Comparing emergency department stress of lateral compression type 1 pelvis fractures with a validated instability scoring system. J Am Acad Orthop Surg 31:e451–e458. https://doi.org/10.5435/JAAOS-D-22-00160CrossRefPubMed

35.

Strage K, Parry J, Mauffrey C (2021) Standardizing statistics and data reporting in orthopaedic research. Eur J Orthop Surg Traumatol 31:1–6. https://doi.org/10.1007/S00590-020-02843-8CrossRefPubMed

36.

Hadeed M, Strage K, Heare A et al (2021) Sacral fracture completeness in lateral compression type 1 pelvic ring injuries has weak interobserver reliability. J Orthop Trauma 35:650–653. https://doi.org/10.1097/BOT.0000000000002125CrossRefPubMed

Titel: Nonoperative management of minimally displaced lateral compression type 1 (LC1) injuries with comminuted rami fractures is associated with late displacement
verfasst von: Nicholas J. Tucker
Bryan L. Scott
Austin Heare
Stephen C. Stacey
Cyril Mauffrey
Joshua A. Parry
Publikationsdatum: 05.08.2023
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 7/2024
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-023-03646-3

Outcomes following replantation surgery

Original Article

Improving outcomes in traumatic peripheral nerve injuries to the upper extremity

Original Article

Do postoperative outcomes vary between midshaft clavicle fractures of 2, 3, or more than 3 fragments?

Original Article

Principles of microvascular surgery in the upper extremity

General Review

Fluoroscopic images of the sacroiliac joint alone are unable to identify simulated flexion or extension malreduction of the anterior pelvic ring in AO/OTA 61-B2.3 pelvic injuries

Original Article

Femoral neck osteosynthesis using interfragmentary compression or position screw in synthetic bones. What are the mechanical differences?

Original Article

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie erweitert durch Fallbeispiele, Videos und Abbildungen. Zur Fortbildung und Wissenserweiterung, verfasst und geprüft von Expertinnen und Experten der Gesellschaft für Arthroskopie und Gelenkchirurgie (AGA).

Jetzt entdecken!

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Leitlinienkonformes Management thermischer Verletzungen

22.01.2025
Verbrennung
Nachrichten

Thermische Verletzungen gehören zu den schwerwiegendsten Traumen und hinterlassen oft langfristige körperliche und psychische Spuren. Die aktuelle S2k-Leitlinie „Behandlung thermischer Verletzungen im Kindesalter (Verbrennung, Verbrühung)“ bietet eine strukturierte Übersicht über das empfohlene Vorgehen.

Positive Daten für supraskapulären Nervenblock bei Schultersteife

20.01.2025
Schultersteife
Nachrichten

Daten einer aktuellen Metaanalyse sprechen dafür, dass eine Blockade des Nervus suprascapularis bei Schultersteife mit Blick auf Funktion und Schmerzlinderung mindestens so effektiv ist wie eine Physiotherapie oder intraartikulär injizierte Steroide.

Wirbelgleiten: Dem persönlichen Drang zum Versteifen widerstehen!

17.01.2025
Spondylolisthese
Nachrichten

In einer norwegischen Studie schnitt die alleinige Dekompressions-Op. bei Personen mit Wirbelgleiten auch dann nicht schlechter ab, wenn erfahrene Chirurgen/ Chirurginnen eigentlich für eine zusätzliche Versteifung plädiert hätten.

Nackenschmerzen nach Bandscheibenvorfall: Muskeltraining hilft!

15.01.2025
Nackenschmerzen
Nachrichten

Bei hartnäckigen Schmerzen aufgrund einer zervikalen Radikulopathie schlägt ein Team der Universität Istanbul vor, lokale Steroidinjektionen mit einem speziellen Trainingsprogramm zur Stabilisierung der Nackenmuskulatur zu kombinieren.

Update Orthopädie und Unfallchirurgie

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

Newsletter bestellen

Springer Medizin

Nonoperative management of minimally displaced lateral compression type 1 (LC1) injuries with comminuted rami fractures is associated with late displacement