Heather A Vallier1, Jason A Lowe2, Julie Agel3, Brian H Mullis4, Clifford B Jones5, David Teague6, Laurence Kempton7, Anna N Miller8, Clay A Spitler9, Erik Kubiak10, Milton L Chip Routt11, Ross Leighton12, Saam Morshed13, Paul Tornetta14. 1. Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH. 2. University of Arizona, Tucson, AZ. 3. Harborview Medical Center, Seattle, WA. 4. Eskenazi Hospital, Indianapolis, IN. 5. The CORE Institute, University of Arizona, Banner University Medical Center, Phoenix, AZ. 6. University of Oklahoma College of Medicine, Oklahoma City, OK. 7. Carolinas Medical Center, Charlotte, NC. 8. Washington University School of Medicine, St. Louis, MO. 9. University of Mississippi Medical Center, Jackson, MS. 10. University of Utah, Salt Lake City, UT. 11. University of Texas Health Science Center, Houston, TX. 12. Dalhousie University, Halifax, NS, Canada. 13. University of California San Francisco, San Francisco, CA. 14. Boston University Medical Center, Boston, MA.
Abstract
OBJECTIVES: To evaluate unilateral sacral fractures and compare those treated operatively versus nonoperatively to determine indications for surgery. DESIGN: Prospective, multicenter, observational study. SETTING: Sixteen trauma centers. PATIENTS/PARTICIPANTS: Skeletally mature patients with pelvic ring injury and unilateral zone 1 or 2 sacral fractures and without anteroposterior compression injuries. MAIN OUTCOME MEASUREMENTS: Injury plain anteroposterior, inlet, and outlet radiographs and computed tomography scans of the pelvis were evaluated for fracture displacement. RESULTS: Three hundred thirty-three patients with unilateral sacral fractures and a mean age of 41 years with a mean Injury Severity Score of 15 were included. Ninety-two percent sustained lateral compression injuries, and 63% of all fractures were in zone 1. Thirty-three percent of patients were treated operatively, including all without lateral compression patterns. Operative patients were more likely to have zone 2 fractures (54%) and to have posterior cortical displacement (29% vs. 6.2%), both with P < 0.001. Over 60% of all patients had no posterior displacement. Mean rotational displacements comparing the injured side versus the intact side were no different for patients treated operatively compared with those treated nonoperatively. CONCLUSIONS: Most unilateral sacral fractures are minimally or nondisplaced. Many patients with radiographically similar fractures were treated operatively and nonoperatively by different surgeons. This suggests an opportunity to develop consistent indications for treatment. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVES: To evaluate unilateral sacral fractures and compare those treated operatively versus nonoperatively to determine indications for surgery. DESIGN: Prospective, multicenter, observational study. SETTING: Sixteen trauma centers. PATIENTS/PARTICIPANTS: Skeletally mature patients with pelvic ring injury and unilateral zone 1 or 2 sacral fractures and without anteroposterior compression injuries. MAIN OUTCOME MEASUREMENTS: Injury plain anteroposterior, inlet, and outlet radiographs and computed tomography scans of the pelvis were evaluated for fracture displacement. RESULTS: Three hundred thirty-three patients with unilateral sacral fractures and a mean age of 41 years with a mean Injury Severity Score of 15 were included. Ninety-two percent sustained lateral compression injuries, and 63% of all fractures were in zone 1. Thirty-three percent of patients were treated operatively, including all without lateral compression patterns. Operative patients were more likely to have zone 2 fractures (54%) and to have posterior cortical displacement (29% vs. 6.2%), both with P < 0.001. Over 60% of all patients had no posterior displacement. Mean rotational displacements comparing the injured side versus the intact side were no different for patients treated operatively compared with those treated nonoperatively. CONCLUSIONS: Most unilateral sacral fractures are minimally or nondisplaced. Many patients with radiographically similar fractures were treated operatively and nonoperatively by different surgeons. This suggests an opportunity to develop consistent indications for treatment. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Authors: Kenan Kuršumović; Michael Hadeed; James Bassett; Joshua A Parry; Peter Bates; Mehool R Acharya Journal: Eur J Orthop Surg Traumatol Date: 2021-04-16
Authors: Daniel Wagner; Andreas Höch; Philipp Pieroh; Tim Hohmann; Florian Gras; Sven Märdian; Alexander Pflug; Silvan Wittenberg; Christoph Ihle; Notker Blankenburg; Kevin Dallacker-Losensky; Tanja Schröder; Steven C Herath; Hans-Georg Palm; Christoph Josten; Fabian M Stuby Journal: Sci Rep Date: 2022-02-11 Impact factor: 4.379