Joshua A Parry1, August Funk1, Austin Heare1, Stephen Stacey1, Cyril Mauffrey2, Adam Starr3, Brett Crist4, Christian Krettek5, Clifford B Jones6, Conor P Kleweno7, Reza Firoozabadi7, Henry Claude Sagi8, Mike Archdeacon8, Jonathan Eastman9, Joshua Langford10, Michel Oransky11, Murphy Martin12, Peter Cole13, Peter Giannoudis14, Seong-Eun Byun15, Steven J Morgan16, Wade Smith16, Vincenzo Giordano17, Vivek Trikha18. 1. Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO. 2. Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO. Electronic address: Cyril.mauffrey@dhha.org. 3. Department of Orthopaedic Surgery, University of Texas at Southwestern, Dallas, Texas. 4. Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri. 5. Department of Orthopaedic Surgery, University of Munich at Hannover Medical School, Hannover, Germany. 6. Department of Orthopaedic Surgery, Dignity Health Medical Group, Phoenix, Arizona. 7. Department of Orthopaedic Surgery, Harboview Medical Center, University of Washington, Seattle, Washington. 8. Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio. 9. Department of Orthopaedic Surgery, University of California Davis, Sacramento, California. 10. Department of Orthopaedic Surgery, Orlando Regional Medical Center, Orlando, Florida. 11. Department of Orthopaedic Surgery, Aurelia Hospital, Roma, Italy. 12. Department of Orthopaedic Surgery, Tulane University, New Orleans, Louisiana. 13. Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota. 14. Department of Orthopaedic Surgery, University of Leeds, Leeds, United Kingdom. 15. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, SC Korea. 16. Department of Orthopaedic Surgery, Swedish Medical Center, Englewood, Colorado. 17. Department of Orthopaedic Surgery, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil. 18. Department of Orthopaedic Surgery, All India Institute of Medical Sciences, South Delhi, India.
Abstract
INTRODUCTION: There exists substantial variability in the management of pelvic ring injuries among pelvic trauma surgeons. The objective of this study was to perform a comprehensive survey on the management of pelvic ring injuries among an international group of pelvic trauma surgeons to determine areas of agreement and disagreement. METHODS: A 45-item questionnaire was developed using an online survey platform and distributed to 30 international pelvic trauma surgeons. The survey consisted of general questions on the acute management of pelvic ring injuries and questions regarding 5 cases: Lateral compression (LC) type 1 injury, LC-3, Anterior-posterior compression (APC) type 3 injury, a combined vertical shear (VS) injury through the sacrum, and VS injury through sacroiliac joint. Respondents were shown blinded anteroposterior pelvis radiographs and axial computed tomography (CT) images for each case and asked if the injury needed fixation, the type of fixation, the order of fixation, and postoperative weight-bearing status. The Kappa statistic was calculated to assess agreement between respondents for each question. RESULTS: Nineteen out of 30 pelvic trauma surgeons completed the survey. Respondents practiced in Brazil (n = 1), Germany (n = 1), India (n = 1), Italy (n = 1) United Kingdom (n = 1), and the United States (n = 14). Of the 45 questions in this survey, 38 (84%) had minimal to no agreement among the respondents. There was moderate agreement, for performing lumbopelvic fixation when indicated, for anterior and posterior fixation of the LC-3 injury, and on forgoing EUA or stress X-rays for the APC-3 injury. There was strong agreement for open reduction and internal fixation of the anterior pelvic ring in the APC-3 injury and the VS injury through the SI joint. In contrast, LC-1 injury and combined VS pelvic ring injury through the sacrum had no areas of moderate to strong agreement. DISCUSSION: This study identified specific areas of pelvic ring injury management with minimal to no agreement among pelvic trauma surgeons. Future research should target these areas with a lack of agreement to decrease practice variability and improve patient outcomes.
INTRODUCTION: There exists substantial variability in the management of pelvic ring injuries among pelvic trauma surgeons. The objective of this study was to perform a comprehensive survey on the management of pelvic ring injuries among an international group of pelvic trauma surgeons to determine areas of agreement and disagreement. METHODS: A 45-item questionnaire was developed using an online survey platform and distributed to 30 international pelvic trauma surgeons. The survey consisted of general questions on the acute management of pelvic ring injuries and questions regarding 5 cases: Lateral compression (LC) type 1 injury, LC-3, Anterior-posterior compression (APC) type 3 injury, a combined vertical shear (VS) injury through the sacrum, and VS injury through sacroiliac joint. Respondents were shown blinded anteroposterior pelvis radiographs and axial computed tomography (CT) images for each case and asked if the injury needed fixation, the type of fixation, the order of fixation, and postoperative weight-bearing status. The Kappa statistic was calculated to assess agreement between respondents for each question. RESULTS: Nineteen out of 30 pelvic trauma surgeons completed the survey. Respondents practiced in Brazil (n = 1), Germany (n = 1), India (n = 1), Italy (n = 1) United Kingdom (n = 1), and the United States (n = 14). Of the 45 questions in this survey, 38 (84%) had minimal to no agreement among the respondents. There was moderate agreement, for performing lumbopelvic fixation when indicated, for anterior and posterior fixation of the LC-3 injury, and on forgoing EUA or stress X-rays for the APC-3 injury. There was strong agreement for open reduction and internal fixation of the anterior pelvic ring in the APC-3 injury and the VS injury through the SI joint. In contrast, LC-1 injury and combined VS pelvic ring injury through the sacrum had no areas of moderate to strong agreement. DISCUSSION: This study identified specific areas of pelvic ring injury management with minimal to no agreement among pelvic trauma surgeons. Future research should target these areas with a lack of agreement to decrease practice variability and improve patient outcomes.