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Clinical Radiology Aug 2019In this review, we discuss the imaging classification of pelvic ring fractures in the context of our experience of reporting trauma computed tomography (CT) in a major... (Review)
Review
In this review, we discuss the imaging classification of pelvic ring fractures in the context of our experience of reporting trauma computed tomography (CT) in a major trauma centre. Pelvic ring fractures are potentially significant injuries with risk of significant haemorrhage and morbidity. This review details the use of classification systems in determining the mechanism and severity of injury, with discussion of the features of the Young and Burgess classification system. We demonstrate the different types of pelvic ring fracture with examples from trauma CT, and with reference to the distribution and frequency of these injuries in trauma patients. This review will allow the reader to assess trauma CT for significant pelvic ring injury and identify features of instability.
Topics: England; Fractures, Bone; Humans; Pelvic Bones; Tomography, X-Ray Computed; Trauma Centers
PubMed: 31153596
DOI: 10.1016/j.crad.2019.04.020 -
The Journal of the American Academy of... Sep 2023Pelvic ring injuries and acetabular fractures are complex injuries and are often challenging to treat for a number of reasons. Orthopaedic trauma surgeons critically...
Pelvic ring injuries and acetabular fractures are complex injuries and are often challenging to treat for a number of reasons. Orthopaedic trauma surgeons critically evaluate pelvic radiographs and CT images to generate an appropriate detailed injury and patient-specific preoperative plan. There are numerous crucial osseous details that surgeons should be aware of. Often, some of the most important factors that affect patients in treatment timing decisions, assessing reduction strategies, and deciding and inserting fixation constructs may be subtle on preoperative imaging. The radiographic and CT imaging findings covered subsequently should be sought out and appreciated preoperatively. Combining all the available osseous information helps the surgeon predict potential pitfalls and adjust surgical plans before incision. Ensuring a methodical and meticulous imaging review allows for the development of a detailed preoperative plan and helps avoid intraoperative missteps. This process will inherently streamline the surgical procedure and optimize the patient's surgical care. Maximizing the accuracy of the preoperative planning process can streamline the treatment algorithm and ultimately contribute to the best possible clinical outcome.
Topics: Humans; Fractures, Bone; Pelvic Bones; Acetabulum; Hip Fractures; Fracture Fixation, Internal; Pelvis; Retrospective Studies
PubMed: 37476846
DOI: 10.5435/JAAOS-D-23-00112 -
Injury Mar 2023High-quality imaging is crucial for orthopedic traumatologists in the evaluation and management of pelvic and acetabular fractures. Computed tomography (CT) plays an... (Review)
Review
High-quality imaging is crucial for orthopedic traumatologists in the evaluation and management of pelvic and acetabular fractures. Computed tomography (CT) plays an essential role in the diagnosis and treatment of patients with these complex injuries. A thoughtful evaluation of associated soft tissues can reveal additional details about the patient and their injury that may impact treatment. This review aims to highlight soft tissue findings that should be identified when evaluating the initial diagnostic imaging after pelvic and acetabular trauma.
Topics: Humans; Fractures, Bone; Pelvic Bones; Acetabulum; Pelvis; Hip Fractures; Tomography, X-Ray Computed
PubMed: 36658024
DOI: 10.1016/j.injury.2023.01.010 -
Cardiovascular and Interventional... Dec 2019Percutaneous vertebroplasty has been a good option to treat vertebral metastases. The pelvic bone is a common site of spread for many cancers. Using follow-up data for... (Observational Study)
Observational Study
BACKGROUND
Percutaneous vertebroplasty has been a good option to treat vertebral metastases. The pelvic bone is a common site of spread for many cancers. Using follow-up data for 126 patients, we evaluated the safety and efficacy of percutaneous osteoplasty (POP) to treat pelvic bone metastases.
MATERIALS AND METHODS
In this retrospective study, 126 patients (mean age 57.45 ± 11.46 years old) with 178 lesions were treated using POP. The visual analog scale (VAS), Oswestry Disability Index (ODI), and the changes in the patient's use of painkillers were used to evaluate pain and quality of life before the procedure, and at 3 days and 1, 3, 6, 9, and 12 months after the procedure.
RESULTS
Technical success was achieved in all patients. The mean VAS scores decreased significantly from 6.87 ± 1.33 before the procedure to 3.33 ± 1.94 by day 3 after the procedure (P < 0.05), 2.26 ± 1.59 at 1 month (P < 0.05), 1.89 ± 1.53 at 3 months (P < 0.05), 1.87 ± 1.46 at 6 months (P < 0.05), 1.90 ± 1.47 at 9 months (P < 0.05), and 1.49 ± 1.17 at 12 months (P < 0.05). The ODI also changed after the procedure, with significant differences between baseline scores and at each follow-up examination (P < 0.05). Pain relief was achieved in 118 patients (93.65%); however, pain relief was not obvious in seven patients (5.56%), and pain was aggravated in one patient (0.79%). Extraosseous cement leakage occurred in 35 patients (27.78%) without causing any clinical complications.
CONCLUSION
Percutaneous osteoplasty is a safe and effective choice for patients with painful osteolytic pelvic bone metastases. It can relieve pain, reduce disability, and improve function.
LEVEL OF EVIDENCE
Level 3b, retrospective study.
Topics: Adult; Aged; Aged, 80 and over; Bone Cements; Bone Neoplasms; Cementoplasty; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pelvic Bones; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 31549190
DOI: 10.1007/s00270-019-02320-8 -
European Journal of Trauma and... Dec 2021
Topics: Fractures, Bone; Humans; Pelvic Bones; Retrospective Studies; Trauma Centers
PubMed: 34845506
DOI: 10.1007/s00068-021-01823-9 -
Colombia Medica (Cali, Colombia) Dec 2020Pelvic fractures occur in up to 25% of all severely injured trauma patients and its mortality is markedly high despite advances in resuscitation and modernization of... (Review)
Review
Pelvic fractures occur in up to 25% of all severely injured trauma patients and its mortality is markedly high despite advances in resuscitation and modernization of surgical techniques due to its inherent blood loss and associated extra-pelvic injuries. Pelvic ring volume increases significantly from fractures and/or ligament disruptions which precludes its inherent ability to self-tamponade resulting in accumulation of hemorrhage in the retroperitoneal space which inevitably leads to hemodynamic instability and the lethal diamond. Pelvic hemorrhage is mainly venous (80%) from the pre-sacral/pre-peritoneal plexus and the remaining 20% is of arterial origin (branches of the internal iliac artery). This reality can be altered via a sequential management approach that is tailored to the specific reality of the treating facility which involves a collaborative effort between orthopedic, trauma and intensive care surgeons. We propose two different management algorithms that specifically address the availability of qualified staff and existing infrastructure: one for the fully equipped trauma center and another for the very common limited resource center.
Topics: Algorithms; Fractures, Bone; Hemodynamics; Humans; Pelvic Bones
PubMed: 33795905
DOI: 10.25100/cm.v51i4.4510 -
American Journal of Surgery Jul 2022The primary aim of this study was to evaluate the role of the initial pelvic X-ray in identifying significant pelvic fractures, which could result in changes in the...
BACKGROUND
The primary aim of this study was to evaluate the role of the initial pelvic X-ray in identifying significant pelvic fractures, which could result in changes in the management of the patient.
METHODS
Patients admitted to a level I trauma center (2010-2019) with a severe blunt pelvic fracture (AIS ≥3) were identified. Included in the analysis were patients who underwent emergency department pelvic X-ray followed by CT scan. A control group of patients without pelvic fractures was also included in the study. All investigations were reviewed by a blinded attending trauma radiologist. Pelvic X-ray findings and CT scan reports were compared according to the specific pelvic fracture location, and severity.
RESULTS
Overall, pelvic X-ray was diagnosed 252 of the 285 pelvic fractures (sensitivity 88.4%) and wrongly diagnosed a facture in 3 of 97 patients without a fracture (specificity 96.9%). In 29/184 (15.8%) of patients with pelvic fracture AIS 3, the pelvic X-ray was read as normal, missing the fracture, compared with 4/101 (4.0%) in the AIS 4/5 group (p = 0.003). Pelvic X-ray had the lowest sensitivity in ischial (10.7%), iliac (28.7%), acetabular (42.4%), and sacral fractures (49.1%) and was best for detecting symphysis diastasis (89.8%).
CONCLUSION
Pelvic X-ray is useful in identifying pubic symphysis diastasis. However, it misses or underestimates a significant number of fractures. CT scan evaluation should be performed in patients with a suspicious mechanism or clinical suspicion of pelvic fracture.
Topics: Fractures, Bone; Humans; Pelvic Bones; Radiography; Retrospective Studies; Spinal Fractures; X-Rays
PubMed: 35131085
DOI: 10.1016/j.amjsurg.2022.01.009 -
Journal of Surgical Oncology Sep 2023Percutaneous pelvic stabilization is an emerging technique that provides mechanical stability to pathologic fractures of the pelvic ring and acetabulum. Variability... (Review)
Review
Percutaneous pelvic stabilization is an emerging technique that provides mechanical stability to pathologic fractures of the pelvic ring and acetabulum. Variability exists in procedural technique among institutions; however, early case series consistently demonstrate an acceptable complication profile and significant improvement in patients' pain and function. This minimally invasive approach is less morbid than traditional, open acetabular and pelvic reconstructions. Therefore, this procedure is an encouraging palliative intervention for a growing patient population in need.
Topics: Humans; Fractures, Bone; Fracture Fixation, Internal; Bone Screws; Acetabulum; Bone Diseases; Pelvic Bones
PubMed: 37537985
DOI: 10.1002/jso.27383 -
The Journal of International Medical... Jun 2021The number of patients with metastatic bone tumors of the pelvis (MBTP) has increased, and the risk of metastasis and recurrence in the pelvic bones is difficult to...
OBJECTIVE
The number of patients with metastatic bone tumors of the pelvis (MBTP) has increased, and the risk of metastasis and recurrence in the pelvic bones is difficult to assess. Therefore, we investigated the clinical features and oncological outcomes of patients with MBTP.
METHODS
We analyzed the clinical features and oncological outcomes of MBTP in 72 patients (42 men, 30 women; mean age, 50.5 years) from 2008 to 2017. Recurrence in the pelvic bones and survival rates were analyzed with regard to patients' potential contributing factors.
RESULTS
Enneking region I was the area most commonly containing MBTP (47.3%). Low- and high-grade tumors were identified in 40 and 32 patients, respectively. The most common pathological type was adenomatous carcinoma (34.7%), and the most common primary lesion was lung cancer (20.8%). The 3-year overall recurrence rate within the pelvic bones was 34.7%, and the 5-year overall survival rate was 29.2%.
CONCLUSION
Patients with MBTP have a high risk of recurrence in the pelvic bones and poor survival after multimodal treatment. Pelvic recurrence might be affected by the metastatic involvement, tumor grade, surgical margins, and type of surgery, whereas the survival rate tends to be associated with the tumor grade.
Topics: Bone Neoplasms; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvic Bones; Pelvic Neoplasms; Pelvis; Retrospective Studies
PubMed: 34154434
DOI: 10.1177/03000605211013152 -
The Journal of the American Academy of... Sep 2023Pelvic ring injuries and acetabular fractures can be complex and challenging to treat. Orthopaedic trauma surgeons scrutinize pelvic radiographs and accompanying CT...
Pelvic ring injuries and acetabular fractures can be complex and challenging to treat. Orthopaedic trauma surgeons scrutinize pelvic radiographs and accompanying CT images for the osseous details that help create a thorough patient-specific preoperative plan. While the osseous details are incredibly important, the surrounding soft-tissue structures are equally as critical and can have a tremendous effect on both the patient and the surgeon. These findings may change surgery timing, dictate the need for additional surgeons or multidisciplinary teams, and determine the treatment sequence. The structures and potential clinical findings reviewed and demonstrated through example images should be sought out during physical examination and correlative preoperative imaging review. Combining all the available osseous and nonosseous information with a detailed approach helps the surgeon predict potential pitfalls and adjust surgical plans before incision. Maximizing the accuracy of the preoperative planning process can streamline treatment algorithm development and ultimately contribute to the best possible clinical patient outcome.
Topics: Humans; Fractures, Bone; Acetabulum; Fracture Fixation, Internal; Pelvis; Radiography; Hip Fractures; Pelvic Bones
PubMed: 37450836
DOI: 10.5435/JAAOS-D-23-00190