H Schmal1, L Froberg2, M S Larsen3, N P Südkamp4, T Pohlemann5, E Aghayev6, K Goodwin Burri7. 1. Department of Orthopaedics and Traumatology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Odense, Denmark and Department of Orthopaedics and Trauma Surgery, Medical Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany. 2. Department of Orthopaedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 3. Department of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark and Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 4. Department of Orthopaedics and Trauma Surgery, Medical Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany. 5. Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany. 6. Spine Centre Division, Department of Research and Development, Schulthess Klinik, Zurich, Switzerland. 7. Swiss Medical Registries and Data Linkage (SwissRDL), Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
Abstract
Aims: The best method of treating unstable pelvic fractures that involve the obturator ring is still a matter for debate. This study compared three methods of treatment: nonoperative, isolated posterior fixation and combined anteroposterior stabilization. Patients and Methods: The study used data from the German Pelvic Trauma Registry and compared patients undergoing conservative management (n = 2394), surgical treatment (n = 1345) and transpubic surgery, including posterior stabilization (n = 730) with isolated posterior osteosynthesis (n = 405) in non-complex Type B and C fractures that only involved the obturator ring anteriorly. Calculated odds ratios were adjusted for potential confounders. Outcome criteria were intraoperative and general short-term complications, the incidence of nerve injuries, and mortality. Results: Operative stabilization reduced mortality by 36% (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.42 to 0.98) but the incidence of complications was twice as high (OR 2.04, 95% CI 1.57 to 2.64). Mortality and the incidence of neurological deficits at discharge were no different after isolated posterior or combined anteroposterior fixation. However, the odds of both surgical (98%, OR 1.98, 95%CI 1.22 to 3.22) and general complications (43%, OR 1.43, 95% CI 1.02 to 2.00) were higher in the group with the more extensive surgery. Conclusion: Operative stabilization is recommended for non-complex unstable pelvic fractures. The need for anterior fixation of obturator ring fractures should, however, be considered critically. Cite this article: Bone Joint J 2018;100-B:973-83.
Aims: The best method of treating unstable pelvic fractures that involve the obturator ring is still a matter for debate. This study compared three methods of treatment: nonoperative, isolated posterior fixation and combined anteroposterior stabilization. Patients and Methods: The study used data from the German Pelvic Trauma Registry and compared patients undergoing conservative management (n = 2394), surgical treatment (n = 1345) and transpubic surgery, including posterior stabilization (n = 730) with isolated posterior osteosynthesis (n = 405) in non-complex Type B and C fractures that only involved the obturator ring anteriorly. Calculated odds ratios were adjusted for potential confounders. Outcome criteria were intraoperative and general short-term complications, the incidence of nerve injuries, and mortality. Results: Operative stabilization reduced mortality by 36% (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.42 to 0.98) but the incidence of complications was twice as high (OR 2.04, 95% CI 1.57 to 2.64). Mortality and the incidence of neurological deficits at discharge were no different after isolated posterior or combined anteroposterior fixation. However, the odds of both surgical (98%, OR 1.98, 95%CI 1.22 to 3.22) and general complications (43%, OR 1.43, 95% CI 1.02 to 2.00) were higher in the group with the more extensive surgery. Conclusion: Operative stabilization is recommended for non-complex unstable pelvic fractures. The need for anterior fixation of obturator ring fractures should, however, be considered critically. Cite this article: Bone Joint J 2018;100-B:973-83.
Authors: Andreas Höch; Philipp Pieroh; Florian Gras; Tim Hohmann; Sven Märdian; Francis Holmenschlager; Holger Keil; Hans-Georg Palm; Steven C Herath; Christoph Josten; Hagen Schmal; Fabian M Stuby Journal: Int Orthop Date: 2019-04-04 Impact factor: 3.075