The royal victoria hospital is a tertiary trauma centre receiving pelvic injury referrals for a population of 1.7 million. The use of ilio-sacral screw fixation with low anterior frame stabilisation has been adopted as the principle treatment for unstable
This study aims to develop a pre-operative protocol for the Australian population, regarding the safe number of screws and size of screw that may be placed. Additionally, results from the study may help identify patients at increased risk of injury during PCSP.
Safe corridor measurements of the PE and AC were taken in the control patients. Pelvic CT scans, taken as part of trauma protocol, were reconstructed using 3D modelling and the dimensions of the whole (3 dimensional) safe corridor measured. The accuracy of screw placement was determined in each treated patient. Accuracy was assessed by the screenshot method, the post-operative CT method or by both methods. In both methods, accuracy was taken as the deviation between the positions of the actual screw and planned screw.
The mean ± (standard deviation, SD) minimum measurement of the safe corridor at the PE was 15.6 ± 2.3 mm (range 11.6 mm to 20.2 mm) and at the AC was 5.9 ±1.6 mm (range 3.0 mm to 10.0 mm). The mean ± (SD) accuracy of screw placement was 6.1 ± 5.3 mm and ranged from a displacement of 1.3 mm to 16.1 mm.
We reviewed 110 patients with an unstable fracture of the pelvic ring who had been treated with a trapezoidal external fixator after a mean follow-up of 4.1 years. There were eight open-book (type B1, B3-1) injuries, 62 lateral compression (type B2, B3-2) and 40 rotationally and vertically unstable (type C1-C3) injuries. The rate of complications was high with loss of reduction in 57%, malunion in 58%, nonunion in 5%, infection at the pin site in 24%, loosening of the pins in 2%, injury to the lateral femoral cutaneous nerve in 2%, and pressure sores in 3%. The external fixator failed to give and maintain a proper reduction in six of the eight open-book injuries, in 20 of the 62 lateral compression injuries, and in 38 of the 40 type-C injuries. Poor functional results were usually associated with failure of reduction and an unsatisfactory radiological appearance. In type-C injuries more than 10 mm of residual vertical displacement of the injury to the posterior pelvic ring was significantly related to poor outcome. In 14 patients in this unsatisfactory group poor functional results were also affected by associated nerve injuries. In lateral compression injuries the degree of displacement of fractures of the pubic rami caused by internal rotation of the hemipelvis was an important prognostic factor. External fixation may be useful in the acute phase of resuscitation but it is of limited value in the definitive treatment of an unstable type-C injury and in type-B open-book injuries. It is usually unnecessary in minimally displaced lateral compression injuries.
Unstable pelvic injuries in young children with
an immature pelvis have different modes of failure from those in adolescents
and adults. We describe the pathoanatomy of unstable pelvic injuries
in these children, and the incidence of associated avulsion of the
iliac apophysis and fracture of the ipsilateral fifth lumbar transverse
process (L5-TP). We retrospectively reviewed the medical records
of 33 children with Tile types B and C pelvic injuries admitted
between 2007 and 2014; their mean age was 12.6 years (2 to 18) and
12 had an immature pelvis. Those with an immature pelvis commonly
sustained symphyseal injuries anteriorly with diastasis, rather
than the fractures of the pubic rami seen in adolescents. Posteriorly,
transsacral fractures were more commonly encountered in mature children,
whereas sacroiliac dislocations and fracture-dislocations were seen
in both age groups. Avulsion of the iliac apophysis was identified
in eight children, all of whom had an immature pelvis with an intact
ipsilateral L5-TP. Young children with an immature pelvis are more
susceptible to pubic symphysis and sacroiliac diastasis, whereas
bony failures are more common in adolescents. Unstable pelvic injuries
in young children are commonly associated with avulsion of the iliac
apophysis, particularly with displaced SI joint dislocation and
an intact ipsilateral L5-TP. Cite this article:
Determine the infection risk of nonoperative versus operative repair of extraperitoneal bladder ruptures in patients with
Aims. This study aimed to analyze the correlation between transverse
process (TP) fractures of the fourth (L4) and fifth (L5) lumbar
vertebrae and biomechanical and haemodynamic stability in patients
with a
Aims: Evaluation of: 1/ type and incidence of
Purpose of study. To review the treatment and outcomes of paediatric
To evaluate efficacy and outcome of embolisation following
Purpose: To evaluate efficacy and outcome of embolisation following
Aim of study: To evaluate infectious complications in patients operated for
Traditionally, unstable anterior
Sacral fractures are often underdiagnosed, but are frequent in the setting of
Variations in pelvic anatomy are a major risk factor for misplaced percutaneous sacroiliac screws used to treat unstable posterior
Introduction: Injuries to the bony pelvis are a significant group of injuries with often serious implications. The close proximity of the bony pelvis to vital organs, it’s involvement in weight bearing and ambulation, and the high energy mechanisms usually required to produce these injuries produces a variety of injury patterns, associated injuries and possible outcomes. Aims: To determine the long-term functional outcomes of displaced
The rate of arterial injury in trauma patients with pelvic ring fractures has been cited as high as 15%. Addressing this source of hemorrhage is essential in the management of these patients as mortality rates are reported as 50%. Percutaneous techniques to control arterial bleeding, such as embolization and REBOA, are being employed with increasing frequency due to their assumed lower morbidity and invasiveness than open exploration or cross clamping of the aorta. There are promising results with regards to the mortality benefits of angioembolization. However, there are concerns with regards to morbidity associated with embolization of the internal iliac vessels and its branches including surgical wound infection, gluteal muscle necrosis, nerve injury, bowel infarction, and thigh / buttock claudication. The primary aim of this study is to determine whether pelvic arterial embolization is associated with surgical site infection (SSI) in trauma patients undergoing pelvic ring fixation. This observational cohort study was conducted using US trauma registry data from the American College of Surgeons (ACS) National Trauma Database for the year of 2018. Patients over the age of 18 who were transported through emergency health services to an ACS Level 1 or 2 trauma hospital and sustained a pelvic ring fracture treated with surgical fixation were included. Patients who were transferred between facilities, presented to the emergency department with no signs of life, presented with isolated penetrating trauma, and pregnant patients were excluded from the study. The primary study outcome was surgical site infection. Multivariable logistic regression was performed to estimate treatment effects of angioembolization of pelvic vessels on surgical site infection, adjusting for known risk factors for infection. Study analysis included 6562 trauma patients, of which 508 (7.7%) of patients underwent pelvic angioembolization. Overall, 148 (2.2%) of patients had a surgical site infection, with a higher risk (7.1%) in patients undergoing angioembolization (unadjusted odds ratio (OR) 4.0; 95% CI 2.7, 6.0; p < 0 .0001). Controlling for potential confounding, including patient demographics, vitals on hospital arrival, open fracture, ISS, and select patient comorbidities, pelvic angioembolization was still significantly associated with increased odds for surgical site infection (adjusted OR 2.0; 95% CI 1.3, 3.2; p=0.003). This study demonstrates that trauma patients who undergo pelvic angioembolization and operative fixation of
Introduction: Early mortality associated with unstable
Introduction: Unilateral posterior
We report the functional and socioeconomic long-term
outcome of patients with
There is controversy regarding the optimum method of stabilising traumatic anterior
Aim. Evaluate the outcome and complications of anterior pubic symphysis plating in the stabilisation of traumatic anterior
Deep infection after acetabular fracture surgery is a serious complication, ranging between 1.2% and 2.5% and has been a challenge for patients and surgeons. It increases length of hospital stay by three to four times due to the need of extra surgeries for debridement, impairs future patient's mobility, and increases the overall costs of care. Aim: We aim to identify pre- and intra-operative risk factors associated with deep infections in surgically treated acetabular fractures. Methods: In a single-center retrospective case-control study, 447 consecutive patients who underwent open reduction and internal fixation of acetabular fractures were included in the study. Diagnosis of surgical site infections required a combination of clinical signs and positive tissue culture or histological signs of tissue infection according to Lipsky et al (2010) and Fleischer et al (2009). To evaluate risk factors from SSI we performed uni- and multivariate analysis by multiple logistic regression. Results: Among 447 patients studied, 23 (5.1%) presented diagnosis of postoperative infection. 349 (78.1%) were male with a mean age of 33.3 years old. Posterior wall fractures accounted for 119 cases (26.6%) followed by 102 (22.8%) double column fractures and 57 (12.8%) T fractures. Factors associated with a significantly risk of infection were patient-related: older age and alcoholism (OR = 5.15, 95% CI = 1.06 to 21.98; p=0.036); trauma-related: fractures of the lower limb (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.8 to 6.78; p=0.017), comminution (OR = 3.6, 95% CI = 1.19 to 8.09; p=0.009),
Aim. To evaluate the outcome and complications of pubic symphysis plating in the stabilisation of traumatic anterior
Sacroiliac screw fixation is the method of choice for the definitive treatment of unstable posterior
Purpose of study. Unstable
Aims: To determine the incidence and pattern of pain in patients with displaced
We aimed to determine multi-modality outcomes in surgically treated patients with high energy
Much interest and controversy have arisen regarding treatment and prognosis of unstable pelvic fractures. The choice of treatment should be based to a large extent on the long-term outcome. Residual vertical displacement and sacroiliac joint involvement are often cited as being related to poor outcome. This study attempts to clarify whether residual vertical displacement or location of posterior
Introduction: The incidence, outcome and recovery of operatively managed pelvic ring fractures were studied from a three-year cohort of patients. No previous published studies have reviewed the factors influencing the outcome of operative stabilization on the neural function and natural recovery in these potentially devastating injuries. Methods: This retrospective case series study of 489 referrals to a tertiary referral unit, from 1st Jan 2004 to 31st Dec 2006, identified 42 (8.6%) patients who had sustained
Aims: To evaluate the outcome after early angiographic embolization in
Introduction: Injuries to the urinary tract are a well known complication in patients with pelvic trauma. A severe urological injury frequently results in adverse long term outcome and prolonged disability. We present a review of the results of management of urological injury and the impact on final outcome in patients with pelvic fractures. Patients: Out of 554 patients admitted to our center with pelvic fracture, 39 with injury to the urinary tract were identified – 8 females and 31 males (study group). The mean age of the patients was 30.9 yrs (range 15 to 71 yrs) and the mean ISS was 12.9 (range 9 to 22). Two patients had a skin wound communicating with fracture hematoma. Seven (18 %) had upper tract injury, 6 (15.4 %) had extraperitoneal bladder rupture, 9 (23.1 %) had intraperitoneal rupture, 3 (7.6 %) had bladder neck injury and 14 (35.9 %) had urethral injury. The mechanism and type of injury, initial management, timing of urological intervention, orthopaedic procedure complications and long term result in terms of incontinence, stricture and sexual dysfunction were assessed. All patients were assessed based on Orthopaedic, urological and the Euroqol (EQ5D) generic health questionnaire and compared to age and sex matched control group of 47 patients with similar pelvic injuries and ISS but no urological injury. The mean follow up period was 2.3 years. Results: Upper urinary tract injuries: All were managed nonoperatively and had a uniformly good outcome except one patient who had a traumatic renal vein thrombosis and required nephrectomy. Three had acetabular fractures (one ant column and 2 both column fractures) and 4 had
Crescent fracture dislocations are a well-recognised subset of
Aim: To review treatment, results and complications of
Aim. Posttraumatic pelvic-osteomyelitis is one of the most serious complications after pelvic-fractures. The necessary extensive surgical debridement as part of interdisciplinary treatment is complicated by the possible persistence of pelvic instability. The aim of this study was to determine the outcome and outline the course of treatment after early posttraumatic pelvic bone infections due to type-C
The aim of this study was to assess the incidence, management and survival of unstable
Purpose of study:. The presence of an L5 transverse process fracture is reported in many texts to be a marker of pelvis fracture instability. There is paucity of literature to support this view. Available studies have been performed on patients who were already known to have a pelvis fracture. No study has attempted to document the presence of this lesion in the absence of a pelvis fracture. Primary aim: To identify the correlation between the presence of a L5 transverse process fracture and an unstable
Stoppa approach has recently been adapted for pelvic surgery as it allows direct intra-pelvic reduction and fixation of the quadrilateral plate and anterior column. We report our early experience, indications and complications with this exposure introduced in 2010 in our tertiary unit. A Retrospective review of all Stoppa approaches in pelvic-acetabular fixations was performed from a prospectively maintained database. Of the 25 patients, mean age 40 years (range 15–76), who underwent pelvic-acetabular fixation using Stoppa approach, 21 patients had mean follow up of 7.3 months (1–48 months). All except 24% of patients had one or more additional systemic injury some requiring additional surgery. There were 6 acetabular fractures, 13
Injuries to the lower urinary tract are well recognized following fractures to the pelvic ring. The overall incidence of pelvic fractures is similar in men and women. However associated urological injuries occur less frequently in women. There are very few reported cases of combined bladder and urethral injury or combined intra- and extraperitoneal bladder rupture in women. Only two cases have been reported describing communication of the hip joint and an extra peritoneal bladder rupture. To our knowledge we are the first to describe a
Various techniques have been used for the fixation of the posterior pelvis, each with disadvantages specific to the technique. In this study, a new protocol involving the placement of posterior pelvic screws in the CT suite is described and evaluated. A total of 66 patients with unstable
Introduction. The aim of this study was to evaluate the health quality of life and return to sports activities following
Background. Acetabular or
Objectives. The additive use of an external modular device may improve dorsal compression forces in pelvic external fixation. This would improve the efficiency of indirect reduction and stabilization with an anterior pelvic external fixator. The purpose of this study was to determine the forces of the posterior pelvis achieved by a new device improving the application of a supraacetabular anterior external fixator compared with other constructs. Material and Method. Synthetic pelvic models were used. Complete pelvic ring instability was created by symphyseal and unilateral sacroiliac joint disruption. Four different constructs of fixation were tested. A pressure-sensitive film was placed in the sacroiliac joint. The constructs were applied in a standardized way. The maximum sacroiliacal compression loads (N) of each trial was recorded. Statistics was performed with the student t-test. Results. Standard supraacetabular two-pin external fixator achieved a dorsal compression load of 13.84 (SD 8.13). The new dorsal pelvic compression device delivered 177.05N (SD 32.32) of load across the sacroiliac joint when the pins were inserted half way and 183.58N (SD 46.64) with full pin insertion. Both the half- and full-pin construct demonstrated a significant dorsal load improvement with the pelvic compressor (p<0.05) compared with the standard supraacetabular fixator group. The C-clamp revealed compression forces of 384.88N (SD 22.95), which was significantly greater than all the other groups (p<0.05). Conclusion. We tested a simple and new modular device for improved application of pelvic external fixation. The centres of rotation of supra-acetabular pins were determined and used to achieve greater dorsal compression forces in disrupted
Aim: To establish a method of emergency and definitive stabilisation of Type C
Background: Acetabular or
Aims: To determine the incidence and pattern of sexual dysfunction in patients with displaced
Aims: Various techniques for the þxation of the posterior pelvis have been used, each demonstrating drawbacks speciþc to the technique. In this study, a new protocol was described and evaluated, involving the placement of posterior pelvic screws in the computed tomography (CT) room. Methods: Between September 2001 and September 2002, sixteen patients with unstable
We investigated whether lateral compression type I injuries of the pelvic ring are inheritably mechanically stable. Between January 2005 to January 2007 all consecutive admissions of a tertiary referral center for pelvic ring reconstruction with a LC I injury pattern were eligible for inclusion. Exclusion criteria were other patterns of
Introduction:
Aim: To investigate whether lateral compression type I injuries of the pelvic ring are inheritably mechanically stable. Patients and Methods: Between January 2005 to January 2007 all consecutive admissions of a tertiary referral center for pelvic ring reconstruction with a LC I injury pattern were eligible for inclusion. Exclusion criteria were other patterns of
Summary. Application of RSA in supine and standing positions allows pelvic fracture stability to be measured more accurately than current techniques. RSA may enable a better understanding of these injuries. Introduction. The in vivo stability of the pelvic ring after fracture stabilisation remains unknown. Plain radiographs have a low accuracy in diagnosing loss of fracture reduction over time. Radiostereometric analysis (RSA) is an accurate imaging measurement method that has previously been applied to measure the healing of other fractures. This pilot study investigated the potential application of RSA in supine and standing positions to measure pelvic fracture stability over time and under weightbearing load. Methods. Five patients with a similar type C pelvic ring disruption who were all operated on using the same surgical technique and had RSA markers inserted at the time of surgery. All five patients had a unilateral comminuted sacral fracture lateral to the sacral foramina treated with posterior plating and pubic rami fractures stabilised by external fixation for six weeks. All patients were mobilised partial weight bearing after regaining leg control. RSA examinations at 2, 4, 12, 26 and 52 weeks included three radiographic pairs taken in supine, standing and supine positions at each time point. Two additional RSA examinations were performed the day prior and post pin removal at 6 weeks. Results. All patients ambulated before the 2 week follow-up and progressed uneventfully. At latest follow-up, there were no complications. Minimal displacements (translations less than 0.3mm and rotations less than 0.5°) were recorded between the supine exams pre and post standing at 2 weeks. Hence, the supine examination was found to be a reliable position to measure the migration of the ilium over time. No loss of reduction was identifiable on plain radiographs over time. At 52 weeks, in contrast to plain radiographic results, RSA measurements revealed that one patient had a fracture migration greater than 4mm. Such large displacements could result in sacral nerve root transection, leading to devastating consequences, such as incontinence, for patients whose sacral fractures are through or medial to the sacral foramina. In one patient, the migration recorded for the apparent uninjured posterior complex side exceeded the migration of the injured side suggesting an unrecognised bilateral injury. Comparative RSA examinations pre and post external fixator removal demonstrated that in three patients the injured hemipelvis migrated greater than 2mm after the removal of the external fixator, which may be indicative that the fixator was removed prematurely. Discussion and Conclusion. The application of RSA allows accurate measurement of pelvic fracture stability which is difficult, if not impossible, to identify and quantify with any other imaging techniques. Hence, RSA has the capacity to enable a better understanding of