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European Journal of Trauma and... Apr 2023Although many articles report complications after pelvic ring and acetabular fracture surgery, a general overview of complication rates and potential risk factors is... (Review)
Review
INTRODUCTION
Although many articles report complications after pelvic ring and acetabular fracture surgery, a general overview of complication rates and potential risk factors is lacking. The current review provides a comprehensive summary of the complications after pelvic ring and acetabular fracture surgery in relation to the surgical approach.
MATERIAL AND METHODS
Pubmed and Embase databases were systematically searched using the key words: pelvic fracture, acetabular fracture, fixation, surgical approaches, complications, and their synonyms. Extracted data included patient and fracture characteristics, surgical approaches, and post-operative complications; surgical site infections (SSI), implant-related complications, malunion and non-union. Study data were summarized using descriptive statistics.
RESULTS
Twenty-two studies (twenty-one retrospective cohort studies, of which three comparative, and one randomized controlled trial) were included in this review. The overall complication rates reported for the included surgical approaches were: 17% for the (Modified) Stoppa approach, 11% for percutaneous fixation, 5% for the Kocher-Langenbeck approach, 7% for the ilioinguinal approach and 31% for external fixation. The most frequent complications were SSI (22%) and neurological (31%) complications, which were most often reported in patients treated with an external fixator. Re-operation rates were comparable for the surgical approaches (4-8%). Two studies reported on risk factors and identified concomitant traumatic injuries, prolonged ICU stay and high body mass index as risk factors for SSI.
CONCLUSION
External fixation of pelvic fractures is associated with highest complications rates including SSI's and neurological complications. Although post-operative complications are frequently reported after pelvic fracture surgery, more studies are needed that identify potential risk factors. These will assist the surgeon in (pre)operative decision making and development of preventive strategies.
Topics: Humans; Fracture Fixation, Internal; Acetabulum; Retrospective Studies; Fractures, Bone; Pelvic Bones; Hip Fractures; Spinal Fractures; Surgical Wound Infection; Randomized Controlled Trials as Topic
PubMed: 36434301
DOI: 10.1007/s00068-022-02118-3 -
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 -
Orthopaedic Surgery Jun 2020To preliminarily study the efficacy and safety of stop-flow pelvic chemoperfusion, a novel therapeutic strategy for treating pelvic malignancies.
OBJECTIVE
To preliminarily study the efficacy and safety of stop-flow pelvic chemoperfusion, a novel therapeutic strategy for treating pelvic malignancies.
METHODS
Stop-flow chemoperfusion was performed six times in 5 patients with primary pelvic malignancies. Aortic and vena cave balloons and tourniquets were used to isolate pelvic blood flow from systemic circulation. Cisplatin was then perfused through a transarterial catheter to achieve exposure to a higher drug concentration. Pelvic and peripheral blood samples were collected to determine drug concentration during perfusion. The efficacy of stop-flow pelvic perfusion was assessed by measuring the change in tumor size, the visual analogue scale, and the tumor necrosis rate after perfusion. Safety was assessed by classifying adverse events according to CTCAE v4.03.
RESULTS
The mean area under the curve (AUC) and maximum drug concentration in the pelvis during perfusion were 246.23 min μg/mL and 17.29 μg/mL, respectively. These measures were significantly higher than the peripheral mean AUC and maximum drug concentration of 52.08 min μg/mL and 5.14 μg/mL, respectively. All 5 patients showed stable disease in response, with changes in tumor size of -4.7%, -5.4%, +4.7%, -8.4%, and 0.0%. Among the 5 patients, 3 (60%) experienced significant pain relief after perfusion. Three patients underwent surgery, with tumor necrosis of 63%, <60%, and 93%. No severe complications were observed in this study.
CONCLUSIONS
Stop-flow pelvic chemoperfusion resulted in exposure to drug higher concentration with fewer serious complications. These preliminary results suggest that further studies are required to comprehensively assess the therapeutic potential of stop-flow pelvic chemoperfusion in pelvic malignancies.
Topics: Adult; Antineoplastic Agents; Bone Neoplasms; Chemotherapy, Cancer, Regional Perfusion; Cisplatin; Female; Humans; Male; Neoplasm Metastasis; Pain Measurement; Pelvic Bones
PubMed: 32243077
DOI: 10.1111/os.12666 -
Orthopaedics & Traumatology, Surgery &... Oct 2021Floating hip is a rare and potentially serious injury. The objective of this study was to evaluate our management strategy for patients with floating hip.
BACKGROUND
Floating hip is a rare and potentially serious injury. The objective of this study was to evaluate our management strategy for patients with floating hip.
HYPOTHESIS
A standardized strategy with specialised multidisciplinary management is associated with a low mortality rate.
METHODS
Consecutive patients who had surgery to treat floating hip between January 2010 and December 2019 were included in this single-centre retrospective study. Epidemiological, clinical, and radiological data were collected and analysed. Patients were managed according to a standardised strategy adapted to the haemodynamic status and type of floating hip (type A, femoral and pelvic ring fractures; type B, femoral and acetabular fractures; and type C, femoral, acetabular, and pelvic ring fractures). The clinical outcome at last follow-up was determined by a telephone interview, based on the Majeed and Oxford scores, sports resumption, and work resumption. To assess the radiological outcomes, we applied Matta's criteria for the acetabulum and Tornetta's criteria for the pelvic ring.
RESULTS
We included 69 patients with a mean age of 38.5 years. Among them, 39 (57%) had haemodynamic instability requiring embolisation (n=15, 22%) or multiple blood transfusions (n=24, 35%). Type A injuries predominated (n=57, 83%). The need for multiple blood transfusions was significantly associated with type C floating hip, underlining the risk of heavy bleeding with this injury. Two (3%) patients died. When management was complete, the reduction was anatomical or satisfactory for 76% (13/17) of the acetabula according to Matta's criteria (maximum residual displacement <3mm) and for 85% (56/66) of the pelvic rings according to Tornetta's criteria (maximum residual displacement <10mm). One or more complications occurred in 45 (65%) patients. After a mean follow-up of 5 years, the mean Oxford Hip Score in patients with acetabular fractures was 35.5 and the mean Majeed score in patients with pelvic ring fractures was 71.5. Only 30% of patients were able to resume physical activities at the former level and to return to their former professional activities.
CONCLUSION
Type C floating hip, which combines fractures of the pelvic ring and acetabulum, carries a high risk of bleeding. Special attention should be directed to the reduction of pelvic ring fractures, to avoid malunion. Acetabular fractures that are complex in the Letournel classification carry a risk of imperfect reduction. The results of this study confirm the severity of these rare injuries and the need for specialised multidisciplinary management according to a standardised strategy that is appropriate for the haemodynamic status and type of floating hip (A, B, or C).
LEVEL OF EVIDENCE
IV; retrospective study.
Topics: Acetabulum; Adult; Fractures, Bone; Hip Fractures; Humans; Pelvic Bones; Radiography; Retrospective Studies; Treatment Outcome
PubMed: 34214653
DOI: 10.1016/j.otsr.2021.102998 -
Emergency Nurse : the Journal of the... Oct 2023Pelvic fractures caused by high-energy trauma such as falling from a height or road traffic collisions have a high mortality rate and patients are also at high risk of...
Pelvic fractures caused by high-energy trauma such as falling from a height or road traffic collisions have a high mortality rate and patients are also at high risk of life-changing injuries. High-energy trauma to the pelvis is associated with major haemorrhage and injuries to the internal pelvic organs. Emergency nurses have a fundamental role in the initial assessment and management of patients, as well as in their ongoing care once the fracture has been stabilised and bleeding is controlled. This article describes the anatomy of the pelvis, discusses the initial assessment and management of patients who have sustained high-energy pelvic trauma, details the complications of pelvic fractures and explains patients' ongoing care in the emergency department.
Topics: Humans; Adult; Fractures, Bone; Pelvic Bones; Pelvis; Emergency Service, Hospital
PubMed: 36880213
DOI: 10.7748/en.2023.e2151 -
Scientific Reports Mar 2022Haemostatic procedures such as preperitoneal pelvic packing (PPP), pelvic angiography (PA), and internal iliac artery ligation are used for haemorrhage control in pelvic...
Haemostatic procedures such as preperitoneal pelvic packing (PPP), pelvic angiography (PA), and internal iliac artery ligation are used for haemorrhage control in pelvic fracture patients with haemodynamic instability. Pelvic external fixation (PEF) and pelvic binder (PB) are usually applied with haemostatic procedures to reduce the pelvic volume. This study aimed to compare the clinical outcomes between patients who underwent PEF and PB. Among 173 patients with pelvic fracture admitted to the emergency room of three regional trauma centres between January 2015 and December 2018, the electronic charts of haemodynamically unstable patients were retrospectively analysed. Among the 84 patients included in the analysis, 20 underwent PEF with or without PB, and 64 underwent only PB. There were significant differences in tile classification and laparotomy between the PEF and PB groups (p = 0.023 and p = 0.032). PPP tended to be more frequently preformed in the PEF group (p = 0.054), whereas PA tended to be more commonly performed in the PB group than in the PEF group (p = 0.054). After propensity score matching to adjust for differences in patient characteristics and adjunct haemostatic procedure, there was no significant difference in 7-day, 30-day, and overall mortality rates between the PEF and PB groups (10.5% vs 21.1%, p = 0.660, 21.1% vs 26.3%, p = 1.000, and 26.3% vs 26.3%, p = 1.000). Cox proportional hazard regression analysis and multivariate analysis for correction of covariates (age, lactate, and abdominal injury) showed that PEF was not an independent factor for 30-day mortality compared with PB (adjusted hazard ratio, 0.526; 95% confidence interval, 0.092-3.002; p = 0.469). Among the volume reduction procedures performed with other haemostatic procedures in patients with pelvic fracture and haemodynamic instability, PEF did not significantly reduce the 30-day mortality rate compared to PB.
Topics: External Fixators; Fracture Fixation; Fractures, Bone; Hemodynamics; Hemostatics; Humans; Pelvic Bones; Retrospective Studies; Treatment Outcome; Vascular Diseases
PubMed: 35256684
DOI: 10.1038/s41598-022-07694-3 -
European Journal of Orthopaedic Surgery... Jan 2021Pelvic ballistic injuries threaten critical gastrointestinal, vascular, and urinary structures. We report the treatment patterns and injury profiles of ballistic pelvic...
INTRODUCTION
Pelvic ballistic injuries threaten critical gastrointestinal, vascular, and urinary structures. We report the treatment patterns and injury profiles of ballistic pelvic fractures and the association between location of ballistic fractures of the pelvis and visceral injuries.
METHODS
A prospectively collected database at an academic level I trauma center was reviewed for clinical and radiographic data on patients who sustained one or more ballistic fractures of the pelvis. Main outcomes compared included: procedures with orthopedic surgery, emergent surgery, concomitant intrapelvic injuries, and mortality.
RESULTS
Eighty-six patients were included. Eight patients (9.3%) underwent surgical debridement with orthopedic surgery, no ballistic pelvic fractures required surgical stabilization. The anatomical locations of ballistic pelvic fractures included: 10 (14.7%) anterior ring, 13 (19.1%) posterior ring, 27 (39.7%) anterior column, and 18 (20.9%) posterior column. There was a statistically significant association between anterior ring and rectal injury. The association between anterior ring injury and bladder injury approached significance.
CONCLUSIONS
This case series included 86 patients with a ballistic fracture of the pelvis, none requiring pelvic ring surgical stabilization. The unpatterned behavior of these injuries demands a high suspicion for visceral injury, with special attention to the rectum and bladder in the setting of anterior ring involvement.
LEVEL OF EVIDENCE
IV.
Topics: Abdominal Injuries; Acetabulum; Adolescent; Adult; Female; Fractures, Bone; Humans; Male; Middle Aged; Multiple Trauma; Pelvic Bones; Retrospective Studies; Trauma Centers; Wounds, Gunshot; Young Adult
PubMed: 32720105
DOI: 10.1007/s00590-020-02744-w -
Journal of Orthopaedic Research :... Mar 2022Limb-salvaging hemipelvectomy surgeries involving allograft or custom prosthesis reconstruction require high quality remaining pelvic bone for adequate device fixation....
Limb-salvaging hemipelvectomy surgeries involving allograft or custom prosthesis reconstruction require high quality remaining pelvic bone for adequate device fixation. Modeling studies of custom pelvis prosthesis designs typically mirror contralateral pelvic bone material properties to the ipsilateral pelvis. However, the extent of bone material property and geometric symmetry, and thus the appropriateness of mirroring, remains unknown and should be considered when designing or analyzing the performance of pelvic prostheses. This study investigates preoperative differences between ipsilateral and contralateral pelvic bone for patients with a pelvic sarcoma. Computed tomography (CT) data were obtained retrospectively from eight patients with a pelvic sarcoma. Subject-specific computational models of the pelvic bones were constructed from the CT data. Bilateral asymmetry of bone material properties and cross-sectional areas between the ipsilateral and contralateral hemipelvis were quantified at points adjacent to the pelvic sarcoma. Large bilateral asymmetry (>20%) in trabecular but not cortical bone density was observed within 20 mm of the tumor location. Differences in trabecular bone density typically declined with increased distance from the tumor. The greatest bilateral difference in cross-sectional area occurred within 10 mm of the tumor boundary for three patients and within 40 mm from the tumor site for four patients. Our results suggest that pelvic sarcomas can cause significant bilateral asymmetries in trabecular bone density for patients with a pelvic sarcoma. These differences should be taken into account when designing custom implants for this patient population.
Topics: Bone Density; Bone Neoplasms; Humans; Pelvic Bones; Retrospective Studies; Sarcoma; Tomography, X-Ray Computed
PubMed: 33914952
DOI: 10.1002/jor.25067 -
The American Surgeon Aug 2021Traumatic bladder injuries are commonly associated with pelvic fractures. While the majority of intraperitoneal bladder injuries are surgically repaired, extraperitoneal... (Review)
Review
Traumatic bladder injuries are commonly associated with pelvic fractures. While the majority of intraperitoneal bladder injuries are surgically repaired, extraperitoneal bladder injuries (EBIs) can be managed nonoperatively in the absence of complex injury patterns such as bladder neck injury or presence of bone spicules in the bladder. Concern for pelvic hardware contamination is one of the most common reasons for repairing EBIs at the time of orthopedic interventions for pelvic fracture (usually open reduction and internal fixation). However, given the inconsistent and limited evidence, practice patterns are different and largely depend on surgeon preferences and institutional management. In this review, we explore the roots for this concern and summarize the current evidence on risk of pelvic hardware infection with nonoperative management of EBIs.
Topics: Equipment Contamination; Evidence-Based Medicine; Fracture Fixation, Internal; Fractures, Bone; Humans; Open Fracture Reduction; Pelvic Bones; Risk Factors; Surgical Wound Infection; Urinary Bladder
PubMed: 33350852
DOI: 10.1177/0003134820956342 -
Orthopaedic Surgery May 2022To evaluate the morphological asymmetry of pelvic rings existing in healthy individuals in terms of three-dimensional (3D) geometric shapes.
OBJECTIVE
To evaluate the morphological asymmetry of pelvic rings existing in healthy individuals in terms of three-dimensional (3D) geometric shapes.
METHODS
This study was a retrospective self-control study. CT images of healthy pelvises, scanned from Jan 2014 to Jan 2019, were taken from 159 subjects (88 males and 71 females) aged 20 to 59 years (39.1 ± 8.7 years). Digital pelvic ring models were reconstructed from CT images and then flipped over the corresponding sagittal planes to obtain their mirrored models. A 3D deviation analysis of a pelvic ring was conducted between the original model and its mirrored model via model registration and quantification of the geometric differences. Next, the pelvic rings were split to the left and right hipbones. The same flipping procedures as done by pelvic rings were performed for left hipbones to obtain their mirrored models. A 3D deviation analysis was also performed between the left and right hip bones. Quantitative variables representing deviation mainly included the average deviation (AD) and the maximum deviation (MD). MDs over 4 mm and 10 mm were deemed as critical levels for evaluating the severity of asymmetry as per Matta's scoring system. The quantitative assessments of the asymmetry covered pelvic rings, bilateral hip bones and the specific anatomic regions of a hip bone.
RESULTS
157 out of 159 pelvic rings (98.74%) had more than 4 mm of the MD and 27 (16.98%) of them exceeded 10 mm of the MD. The MD of pelvic rings was 1.23 times as high as that for the bilateral hip bones (7.46 mm vs. 6.08 mm, P < 0.05). The ADs of pelvic rings and bilateral hip bones were 1.28 mm and 0.94 mm, respectively (P < 0.05); 2.27% of the surface points of a pelvic ring had more than 4 mm geometric deviations compared with its mirrored model, while 0.59% (P < 0.05) of bilateral hip bones were on the same level of deviation. 119 out of 159 pelvic iliac crests (74.8%) had MDs more than 4 mm, and 15 (9.4%) reached 10 mm or more. Only 15 (9.4%) pelvises presented asymmetric features in the area of obturator foramen where the MDs exceeded 4 mm.
CONCLUSIONS
Pelvic asymmetry exists in the general population, but 3D geometric symmetry is present in specific anatomic regions. It implies that restoring the 3D symmetry of specific anatomic regions is more reliable than "restoring the symmetry of pelvic ring" in pelvic ring reduction or pelvic fixation design.
Topics: Female; Humans; Male; Ilium; Imaging, Three-Dimensional; Pelvic Bones; Retrospective Studies; Young Adult; Adult; Middle Aged
PubMed: 35377554
DOI: 10.1111/os.13246