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Journal of Orthopaedic Trauma Aug 2021Pelvic ring fractures range from low-energy falls in the elderly to high-energy mechanisms in young patients. These injuries can be a significant cause of morbidity and...
Pelvic ring fractures range from low-energy falls in the elderly to high-energy mechanisms in young patients. These injuries can be a significant cause of morbidity and mortality and are frequently associated with additional injuries. Hemorrhage and resultant hemodynamic instability are often associated with high-energy injuries and require prompt management. Circumferential pelvic antishock sheeting is an effective and readily available tool for reducing pelvic volume at the accident scene or in the emergency department, while still allowing access to the abdomen and lower extremities for ongoing resuscitation. This article, and the associated instructional video, reviews the indications and proper technique for placing a pelvic sheet.
Topics: Aged; Fractures, Bone; Hemorrhage; Humans; Pelvic Bones; Pelvis; Resuscitation
PubMed: 34227598
DOI: 10.1097/BOT.0000000000002173 -
The Orthopedic Clinics of North America Jul 2020Percutaneous reduction and fixation of pelvic ring fractures is now widely accepted as a safe and effective treatment method. The only exception remains reduction and... (Review)
Review
Percutaneous reduction and fixation of pelvic ring fractures is now widely accepted as a safe and effective treatment method. The only exception remains reduction and fixation of pubic symphyseal injuries. Several units from China and one from Spain have published clinical and biomechanical studies supporting percutaneous reduction and fixation of the pubic symphysis with various screw configurations. The initial clinical results are promising. Biomechanical data show there is little difference between plate and screw fixation. We review the current literature and also present a case performed by ourselves using this novel technique.
Topics: Fracture Fixation, Internal; Fractures, Bone; Humans; Minimally Invasive Surgical Procedures; Pelvic Bones; Pubic Symphysis
PubMed: 32498950
DOI: 10.1016/j.ocl.2020.02.010 -
Injury Jul 2020Vacuum phenomenon (VP) in closed pelvic fracture is a rare disorder. This study aimed to examine the prevalence and clinical findings of VP in closed pelvic fracture.
BACKGROUND
Vacuum phenomenon (VP) in closed pelvic fracture is a rare disorder. This study aimed to examine the prevalence and clinical findings of VP in closed pelvic fracture.
METHODS
We retrospectively reviewed 197 patients with closed pelvic fracture who presented to our institution from January 2012 to December 2018. Pelvic fractures were diagnosed by plain radiography and computed tomography (CT). First, we investigated the prevalence and clinical findings of VP in pelvic fractures. Second, we compared the clinical findings between pelvic fracture with and without VP. Finally, VP in pelvic fracture was evaluated clinically and radiologically.
RESULTS
VP in pelvic fractures was detected by CT in 9 (3.6%) of the 197 patients with pelvic fractures. Patients with VP had a significantly greater proportion of fracture progression than those without VP (42.9% vs. 11.3%, P = 0.02). Patients with VP had a greater proportion of fragility fractures of the pelvis (FFP), and a lesser proportion of bone union than those without VP, although the differences were not significant. In nine pelvic fractures with VP, all sacral fractures were classified as type 1 according to the Denis classification, and all pubic fractures were classified as type 1 according to the Nakatani classification. Two (22.2%) nonunion in nine pelvic fractures with VP occurred at the pubic fracture site alone.
CONCLUSIONS
Orthopedic clinicians should be aware of the potential of CT for detecting VP in pelvic fractures, especially in the course of FFP progression.
Topics: Aged; Aged, 80 and over; Female; Fractures, Bone; Gases; Hospitals, General; Humans; Japan; Male; Middle Aged; Pelvic Bones; Pubic Bone; Radiography; Retrospective Studies; Sacrum; Tomography, X-Ray Computed; Vacuum
PubMed: 32386839
DOI: 10.1016/j.injury.2020.03.051 -
European Radiology Sep 2022Pelvic bone pathological lesions and traumatic fractures are a considerable source of pain and disability. In this study, we sought to evaluate the effectiveness of...
OBJECTIVES
Pelvic bone pathological lesions and traumatic fractures are a considerable source of pain and disability. In this study, we sought to evaluate the effectiveness of reinforced cementoplasty (RC) in painful and unstable lesions involving the pelvic bone in terms of pain relief and functional recovery.
METHODS
All patients with neoplastic lesion or pelvic fracture for whom a pelvic bone RC was carried out between November 2013 and October 2017 were included in our study. All patients who failed the medical management, patients unsuitable for surgery, and patients with unstable osteolytic lesions were eligible to RC. Clinical outcome was evaluated with a 1-month and 6-month post-procedure follow-up. The primary endpoint was local pain relief measured by the visual analogue scale (VAS).
RESULTS
Twenty-two patients (18 females, 4 males; mean age of 65.4 ± 13.3 years [range 38-80]) presenting with painful and unstable pelvic lesions were treated by RC during the study period. Among the 22 patients, 8 patients presented with unstable pelvic fractures (3 patients with iliac crest fracture, 3 with sacral fractures, and the remaining 2 with peri-acetabular fractures). No procedure-related complications were recorded. All patients had significant pain relief and functional improvement at 1 month. One patient (4.5%) had suffered a secondary fracture due to local tumour progression.
CONCLUSIONS
Reinforced cementoplasty is an original minimally invasive technique that may help in providing pain relief and effective bone stability for neoplastic and traumatic lesions involving the pelvic bone.
KEY POINTS
• Reinforced cementoplasty is feasible in both traumatic fractures and tumoural bone lesions of the pelvis. • Reinforced cementoplasty for pelvic bone lesions provides pain relief and functional recovery. • Recurrence of pelvic bone fracture was observed in 4.5% of the cases in our series.
Topics: Adult; Aged; Aged, 80 and over; Cementoplasty; Female; Fractures, Bone; Humans; Male; Middle Aged; Pain; Pelvic Bones; Pelvic Neoplasms; Spinal Fractures; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 35362749
DOI: 10.1007/s00330-022-08742-2 -
Medicina (Kaunas, Lithuania) Aug 2022: Pelvic nonunion and malunion have been documented as rare complications in pelvic fractures and literature describing these topics is severely limited. Articles... (Review)
Review
: Pelvic nonunion and malunion have been documented as rare complications in pelvic fractures and literature describing these topics is severely limited. Articles dedicated solely to pelvic malunion are nearly nonexistent. We conducted a literature search with the goal of providing a summary of the definition, causes, treatment strategies, and outcomes of pelvic malunion correction. : An initial review of the literature was performed using the PubMed, ScienceDirect, and Cochrane Database of Systematic Reviews databases. Search terms used were "malunion" AND "pelvic" OR "pelvis". Duplicate articles, non-English language articles without translations available and non-human subject studies were excluded. : Eleven original publications were found describing experiences with pelvic malunion. Seven of the articles were exclusively dedicated to the topic of pelvic fracture malunion, and only two reported on a series of patients treated for malunion with variably staged procedures. Most reports define pelvic pain as the main indication for surgical correction, along with gait disturbance, standing or sitting imbalance, and urinary or sexual dysfunction. Radiographically, vertical displacement of one to two centimeters and rotation of the hemipelvis of fifteen degrees or more have been described in defining malunion. No treatment algorithms exist, and each patient is treated with a unique work-up and operative plan due to the complexity of the problem. Only one series reported a patient satisfaction rate of 75% following malunion treatment. Conclusions: Pelvic malunion is a rare complication of pelvic ring injury and is seldom discussed in the literature. We found two small case series reporting exclusively on malunion treatment and complications. While some of the combination studies made the distinction in the diagnosis of malunion and nonunion, they rarely differentiated the treatment outcomes between the two categories. This paper describes pelvic malunion and highlights the need for more research into surgical outcomes of treatment specifically regarding functionality, patient satisfaction, and recurrence of preoperative symptoms.
Topics: Fractures, Bone; Fractures, Malunited; Humans; Pelvic Bones
PubMed: 36013565
DOI: 10.3390/medicina58081098 -
Skeletal Radiology Jul 2020Pelvic bone tumors present a diagnostic and therapeutic challenge. Due to the deep anatomic location and resultant late clinical presentation, pelvic bone tumors tend to... (Review)
Review
Pelvic bone tumors present a diagnostic and therapeutic challenge. Due to the deep anatomic location and resultant late clinical presentation, pelvic bone tumors tend to be large and located in close proximity to pelvic viscera as well as vital neurovascular structures. Operative management of pelvic bone tumors is indicated for a variety of orthopedic oncologic conditions. In general, limb-sparing pelvic resection rather than hemipelvectomy with amputation of the ipsilateral limb is considered when a functional limb can be preserved without compromising the surgical margins. There are various options for pelvic resection and reconstruction, and the selection depends on tumor histology, anatomic location, and extent. The decision regarding choice of surgical procedure and reconstruction method for a pelvic bone tumor requires a thorough knowledge of the pelvic anatomy, and careful inspection of the anatomic extent. The surgical plan must strike a balance between acceptable functional outcome and acceptable morbidity. In this review, we describe the different types of pelvic resection techniques, and the vital role preoperative imaging plays in defining the anatomic extent of a pelvic bone tumor and subsequent surgical planning.
Topics: Bone Neoplasms; Contrast Media; Humans; Imaging, Three-Dimensional; Margins of Excision; Pelvic Bones; Salvage Therapy
PubMed: 32072185
DOI: 10.1007/s00256-020-03395-y -
Der Radiologe Mar 2020Traumatic fractures of the pelvic ring are relatively rare, but are associated with increased risk of mortality. Depending on injury mechanism and main vector of energy... (Review)
Review
EPIDEMIOLOGY
Traumatic fractures of the pelvic ring are relatively rare, but are associated with increased risk of mortality. Depending on injury mechanism and main vector of energy impact, a distinction is made between anteroposterior compression, lateral compression, and vertical shear (Young and Burgess classification), while the stability-related classification according to Tile distinguishes between type A (stable), type B (rotationally unstable) and type C (completely unstable). A comprehensive modern classification is given by the AO/OTA.
RADIOLOGICAL FRACTURE DIAGNOSIS
Plain pelvis x‑rays lack sufficient sensitivity but are still used to detect highly unstable pelvic fractures. CT has superior sensitivity and specificity. In addition to fracture classification, CT allows reliable assessment of associated vascular and bladder/urethral injuries and large soft tissue hemorrhage. MRI is unparalleled in showing bone marrow edema, cauda and plexus complications, and peripelvic soft tissue damage. MRI may also prove to be a valuable diagnostic tool for pelvic ring injuries in children, adolescents and young women, provided they are hemodynamically stable. Angiography, ultrasonography and bone scintigraphy are additional important diagnostic and therapeutic options.
PRACTICAL RECOMMENDATIONS
Knowledge of basic pelvic trauma mechanisms is important to understand the potential severity of traumatic pelvic fractures and to classify them correctly in terms of stability. Being familiar with typical concomitant injuries in pelvic ring fractures allows reliable diagnosis and their communication with the clinician. CT remains the "diagnostic workhorse". In fragile pelvic fractures, the often prolonged course with fracture progression must be taken into account, which is why MRI is of particular importance herein.
Topics: Abdominal Injuries; Adolescent; Child; Female; Fractures, Bone; Humans; Magnetic Resonance Imaging; Pelvic Bones; Pelvis; Tomography, X-Ray Computed
PubMed: 32108247
DOI: 10.1007/s00117-020-00656-8 -
Anatomical Science International Jul 2023Anatomists have been attempting to standardize anatomical terminology of the human body and in doing so created the Terminologia Anatomica as a standard language of... (Review)
Review
Anatomists have been attempting to standardize anatomical terminology of the human body and in doing so created the Terminologia Anatomica as a standard language of anatomy. Despite developments such as the Terminologia Anatomica, a lack of consistency of anatomical terminology is still seen across and within disciplines. This study explores the variation in terminology for the hip bone through a literature review. In total, ten terms used to describe the hip bone were searched in PubMed, JSTOR, and EBSCO databases: "coxal bone," "hip bone," "innominate bone," "os coxa," "os coxae," "ossa coxa," "ossa coxae," "os innominatum," "os pelvicum," and "pelvic bone." Results found that the terms "hip bone" and "pelvic bone" were the most commonly used terms, with the most frequently used discipline being medicine. However, we argue against the use of these terms in favor of "coxal bone" or "innominate bone." "Hip bone" should be avoided due to its colloquial nature, and "pelvic bone" is not specific enough to the structure of the hip. Latin terms are often incorrectly conjugated (e.g., "os coxae"); therefore, the English equivalent should be used when possible. Regardless, standardization of anatomical terminology should be adopted through consensus by practitioners, researchers, and stakeholders.
Topics: Humans; Pelvic Bones; Anatomy
PubMed: 36692627
DOI: 10.1007/s12565-023-00702-0 -
Journal of Pediatric Orthopedics Aug 2023Existing classification systems may not adequately describe the injury patterns seen pelvic ring and acetabular fractures in the skeletally immature population....
BACKGROUND
Existing classification systems may not adequately describe the injury patterns seen pelvic ring and acetabular fractures in the skeletally immature population. Pediatric patients, once stabilized, are often transferred for these injuries. We evaluated which commonly used systems correlate with clinical management in pediatric patients, including transfer patterns based on injury severity.
METHODS
A retrospective review of patients aged 1 to 15 treated for traumatic pelvic or acetabular fractures over a 10-year period at an academic level I Pediatric Trauma Center reviewed demographic, radiographic, and clinical data.
RESULTS
A total of 188 pediatric patients (average age 10.1 y) were included. Increasing injury severity based on classification Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA P <0.001; Young and Burgess P <0.001; Torode/Zieg P <0.001), increasing Injury Severity Score ( P =0.0017), and decreasing hemoglobin levels ( P =0.0144) were significantly associated with operative management. Injury characteristics did not differ between patients who were transferred versus patients who were brought in directly from the field. Air transport was significantly associated with surgical treatment, pediatric intensive care unit admission, polytrauma, and Torode/Zieg classification ( P =0.036, <0.0001, 0.0297, 0.0003, respectively).
CONCLUSIONS
Although not fully descriptive of skeletally immature fracture patterns, the AO/OTA and Young and Burgess classification systems adequately assess the severity of pelvic rings and injuries in pediatric patients and predict management patterns. The Torode and Zieg classification also predicts management. In a large cohort, air transport was significantly associated with surgical treatment, need for pediatric intensive care unit stay, the presence of an additional injury, and instability in the Torode and Zieg classification. These findings suggest that air transfers are being utilized to expedite advanced-level care in more severe injuries. Further studies with long-term follow-up are required to assess the clinical outcomes of both nonoperatively and operatively treated pediatric pelvic fractures and to guide both triage and treatment decisions for these rare but severe injuries.
LEVEL OF EVIDENCE
Level III.
Topics: Humans; Child; Spinal Fractures; Fractures, Bone; Pelvic Bones; Hip Fractures; Pelvis; Injury Severity Score; Retrospective Studies
PubMed: 37130809
DOI: 10.1097/BPO.0000000000002426 -
Injury Oct 2021Open pelvic fractures remain challenging in terms of their management. The purpose of this narrative review was to evaluate the latest advances made in the management of... (Review)
Review
BACKGROUND
Open pelvic fractures remain challenging in terms of their management. The purpose of this narrative review was to evaluate the latest advances made in the management of these injuries and report on their clinical outcome.
PATIENTS AND METHODS
A literature review was undertaken focusing on studies that have been published on the management of open pelvic fractures between January 2005 and November 2019. Information extracted from each article include demographics, mechanism of injury, injury severity score (ISS), classification of pelvic ring fracture, classification of open soft tissue, specific injury zone classification, number of cases with hemodynamic instability, number of cases that received blood transfusions, amount of packed red blood cells transfused during the first 24 h, number of cases with anorectal trauma, urogenital injury, number of fecal diversional colostomies and laparotomies, angiographies and embolization, preperitoneal pelvic packings, length of stay in intensive care unit (ICU) and in hospital, and mortality.
RESULTS
Fifteen articles with 646 cases formed the basis of this review. The majority of patients were male adults (74.9%). The mean age was 35.1 years. The main mechanism of injury was road traffic accidents, accounting for 67.1% of the injuries. The mean ISS was 26.8. A mean of 13.5 units of PRBCs were administered the first 24 h. During the whole hospital stay, 79.3% of the patients required blood transfusions. Angiography and pelvic packing were performed in a range of 3%-44% and 13.3%-100% respectively. Unstable types of pelvic injuries were the majority (72%), whilst 32.7% of the cases were associated with anorectal trauma, and 32.6% presented with urogenital injuries. Bladder ruptures were the most reported urogenital injury. Fecal diversional colostomy was performed in 37.4% of the cases. The mean length of ICU stay was 12.5 days and the mean length of hospital stay was 53.0 days. The mean mortality rate was 23.7%.
CONCLUSION
Mortality following open pelvic fracture remains high despite the evolution of trauma management the last 2 decades. Sufficient blood transfusion, bleeding control, treatments of associated injuries, fracture fixation and soft tissue management remain essential for the reduction of mortality and improved outcomes.
Topics: Adult; Female; Fracture Fixation; Fractures, Bone; Fractures, Open; Humans; Injury Severity Score; Male; Pelvic Bones; Pelvis; Retrospective Studies
PubMed: 32139131
DOI: 10.1016/j.injury.2020.02.096