Treatment of APCII Pelvic Fractures. Variables That Affect the Outcomes
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Published:
Apr 18, 2022
Keywords:
Pelvic fracture, APCII, Majeed score, variables
Main Article Content
Abstract
Introduction: Pelvic fractures are frequently associated with high-energy trauma. Mortality varies from 5%-46%. In these patients, the factors related to poor outcomes are still controversial.
Purpose: To explore if the variables analyzed were related with the long term outcomes of the treatment of an anterior-posterior compression type II pelvic fracture (APCII; AO/OTA: 61B2.3).
Materials and Methods: 79 cases were analyzed and 23 patients remained for evaluation according to inclusion and exclusion criteria. Pelvic radiographs (anteroposterior, inlet and outlet) and CT-scans were evaluated. The Young & Burgess classification was used to define the fracture pattern and the Majeed Score for clinical outcomes. Variables analyzed: emergency treatment, associated injuries, delay for definitive fixation, method of fixation, quality of immediate postoperative reduction and surgical site infection.
Results: We did not find any statistical relation between the type of emergency treatment, associated injuries, delay for definitive fixation, method of fixation, and the long-term clinical outcome. Patients who had an immediate postoperative reduction of less than 1 cm and those who did not have a surgical site infection obtained better functional outcomes (statistically significant).
Conclusion: The quality variables of immediate postoperative reduction and surgical site infection in patients with APCII pelvic fracture had a direct relation with long-term functional and clinical outcomes.
Purpose: To explore if the variables analyzed were related with the long term outcomes of the treatment of an anterior-posterior compression type II pelvic fracture (APCII; AO/OTA: 61B2.3).
Materials and Methods: 79 cases were analyzed and 23 patients remained for evaluation according to inclusion and exclusion criteria. Pelvic radiographs (anteroposterior, inlet and outlet) and CT-scans were evaluated. The Young & Burgess classification was used to define the fracture pattern and the Majeed Score for clinical outcomes. Variables analyzed: emergency treatment, associated injuries, delay for definitive fixation, method of fixation, quality of immediate postoperative reduction and surgical site infection.
Results: We did not find any statistical relation between the type of emergency treatment, associated injuries, delay for definitive fixation, method of fixation, and the long-term clinical outcome. Patients who had an immediate postoperative reduction of less than 1 cm and those who did not have a surgical site infection obtained better functional outcomes (statistically significant).
Conclusion: The quality variables of immediate postoperative reduction and surgical site infection in patients with APCII pelvic fracture had a direct relation with long-term functional and clinical outcomes.
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How to Cite
Rey Moggia, J., Chiodini, M., Galán, F., & Amadei Enghelmayer, R. (2022). Treatment of APCII Pelvic Fractures. Variables That Affect the Outcomes. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(2), 165-176. https://doi.org/10.15417/issn.1852-7434.2022.87.2.1322
Section
Clinical Research
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References
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Kellam JF, Vrahas M (eds). Fractures of the pelvis and acetabulum: principles and methods of management. 4th ed. New York: Thieme; 2015: p. 39-60.
2. Black SR, Sathy AK, Jo MD, Wiley MR, Minei JP, Starr AJ. Improved survival after pelvic fracture: 13-year
experience at a single trauma center using a multidisciplinary institutional protocol. J Orthop Trauma 2016;30:22-8. https://doi.org/10.1097/BOT.0000000000000443
3. Hak DJ, Smith WR, Suzuki T. Management of hemorrhage in life-threatening pelvic fracture. J Am Acad Orthop
Surg 2009;17(7):447-57. https://doi.org/10.5435/00124635-200907000-00005
4. Grimshaw CS, Bledsoe JG, Moed BR. Locked versus standard unlocked plating of the pubic symphysis. J Orthop
Trauma 2012;26:402-6. https://doi.org/10.1097/BOT.0b013e31822c83bd
5. Metze M, Tiemann AH, Josten C. Male sexual dysfunction after pelvic fracture. J Trauma 2007;63:394-401.
https://doi.org/10.1097/01.ta.0000241145.02748.df
6. Meyhoff CS, Thomsen CH, Rasmussen LS, Nielsen PR. High incidence of chronic pain following surgery for pelvic fracture. Clin J Pain 2006;22:167-72. https://doi.org/10.1097/01.ajp.0000174266.12831.a2
7. Musso D, Vindver G, Bidolegui F, Mohanty K, Di Stefano C, Powell J. Manejo en la urgencia de las lesiones del
anillo pelviano. Rev Asoc Argent Ortop Traumatol 2004;69(3):270-80. Disponible en:
https://www.aaot.org.ar/revista/2004/n3_vol69/art14.pdf
8. Nork SE. The management of the injured pelvic ring: internal fixation of the anterior pelvic injuries-open book type (B1). En: Tile M, Helfet DL, Kellam JF, Vrahas M (eds). Fractures of the pelvis and acetabulum: principles and
methods of management. 4th ed. New York: Thieme; 2015: p. 159-74.
9. Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology 1986;160:445-51. https://doi.org/10.1148/radiology.160.2.3726125
10. Whiting PS, Auston D, Avilucea FR, Ross D, Archdeacon M, Sciadini M, et al. Negative stress examination under anesthesia reliably predicts pelvic ring union without displacement. J Orthop Trauma 2017;31:189-93.
https://doi.org/10.1097/BOT.0000000000000766
11. Collinge CA, Archdeacon MT, LeBus G. Saddle-horn injury of the pelvis. The injury, its outcomes, and associated male sexual dysfunction. J Bone Joint Surg Am 2009;91:1630-6. https://doi.org/10.2106/JBJS.H.00477
12. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification
compendium–2018. J Orthop Trauma 2018;32(1):S71-76. https://doi.org/10.1097/BOT.0000000000001066
13. Varga E, Hearn T, Powell J, Tile M. Effects of method of internal fixation of symphyseal disruptions on stability of the pelvic ring. Injury 1995;26(2):75-80. https://doi.org/10.1016/0020-1383(95)92180-i
14. Eastman JG, Krieg JC, Routt ML Jr. Early failure of symphysis pubis plating. Injury 2016;47(8):1707-12.
https://doi.org/10.1016/j.injury.2016.05.019
15. Sagi HC, Coniglione FM, Stanford JH. Examination under anesthetic for occult pelvic ring instability. J Orthop
Trauma 2011;25:529-36. https://doi.org/10.1097/BOT.0b013e31822b02ae
16. Avilucea FR, Whiting PS, Mir H. Posterior fixation of APC-2 pelvic ring injuries decreases rates of anterior plate
failure and malunion. J Bone Joint Surg Am 2016;98(11):944-51. https://doi.org/10.2106/JBJS.15.00723
17. Majeed SA. External fixation of the injured pelvis: the functional outcome. J Bone Joint Surg Br 1990;72:612-14. https://doi.org/10.1302/0301-620X.72B4.2380212
18. Matta JM, Tornetta P 3rd. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res 1996;(329):129-40. https://doi.org/10.1097/00003086-199608000-00016
19. Lefaivre KA, Slobogean GP, Valeriote J, O’Brien PJ, Macadam SA. Reporting and interpretation of the functional
outcomes after the surgical treatment of disruptions of the pelvic ring: a systematic review. J Bone Joint Surg Br
2012;94(4):549-55. https://doi.org/10.1302/0301-620X.94B4.27960
20. Harvey-Kelly KF, Kanakaris NK, Obakponovwe O, West RM, Giannoudis PV. Quality of life and sexual function
after traumatic pelvic fracture. J Orthop Trauma 2014;28:28-35. https://doi.org/10.1097/BOT.0b013e31828fc063
21. Hessmann MH, Rickert M, Hofmann A, Rommens PM, Buhl M. Outcome in pelvic ring fractures. Eur J Trauma
Emerg Surg 2010;36(2):124-30. https://doi.org/10.1007/s00068-010-1042-0
22. Vallier HA, Cureton BA, Ekstein C, Oldenburg FP, Wilber JH. Early definitive stabilization of unstable pelvis and
acetabulum fractures reduces morbidity. J Trauma 2010;69(3):677-84. https://doi.org/10.1097/TA.0b013e3181e50914
23. Suzuki T, Shindo M, Soma K, Minehara H, Nakamura K, Uchino M, et al. Long-term functional outcome after
unstable pelvic ring fracture. J Trauma 2007;63:884-8. https://doi.org/10.1097/01.ta.0000235888.90489.fc
24. Holstein JH, Pizanis A, Köhler D, Pohlemann T; Working Group Quality of Life After Pelvic Fractures. What are
predictors for patients’ quality of life after pelvic ring fractures? Clin Orthop Relat Res 2013;471:2841-5.
https://doi.org/10.1007/s11999-013-2840-y
25. Lefaivre KA, Blachut PA, Starr AJ, Slobogean GP, O’Brien PJ. Radiographic displacement in pelvic ring disruption: reliability of 3 previously described measurement techniques. J Orthop Trauma 2014;28(3):160-6.
https://doi.org/10.1097/BOT.0b013e31829efcc5
Kellam JF, Vrahas M (eds). Fractures of the pelvis and acetabulum: principles and methods of management. 4th ed. New York: Thieme; 2015: p. 39-60.
2. Black SR, Sathy AK, Jo MD, Wiley MR, Minei JP, Starr AJ. Improved survival after pelvic fracture: 13-year
experience at a single trauma center using a multidisciplinary institutional protocol. J Orthop Trauma 2016;30:22-8. https://doi.org/10.1097/BOT.0000000000000443
3. Hak DJ, Smith WR, Suzuki T. Management of hemorrhage in life-threatening pelvic fracture. J Am Acad Orthop
Surg 2009;17(7):447-57. https://doi.org/10.5435/00124635-200907000-00005
4. Grimshaw CS, Bledsoe JG, Moed BR. Locked versus standard unlocked plating of the pubic symphysis. J Orthop
Trauma 2012;26:402-6. https://doi.org/10.1097/BOT.0b013e31822c83bd
5. Metze M, Tiemann AH, Josten C. Male sexual dysfunction after pelvic fracture. J Trauma 2007;63:394-401.
https://doi.org/10.1097/01.ta.0000241145.02748.df
6. Meyhoff CS, Thomsen CH, Rasmussen LS, Nielsen PR. High incidence of chronic pain following surgery for pelvic fracture. Clin J Pain 2006;22:167-72. https://doi.org/10.1097/01.ajp.0000174266.12831.a2
7. Musso D, Vindver G, Bidolegui F, Mohanty K, Di Stefano C, Powell J. Manejo en la urgencia de las lesiones del
anillo pelviano. Rev Asoc Argent Ortop Traumatol 2004;69(3):270-80. Disponible en:
https://www.aaot.org.ar/revista/2004/n3_vol69/art14.pdf
8. Nork SE. The management of the injured pelvic ring: internal fixation of the anterior pelvic injuries-open book type (B1). En: Tile M, Helfet DL, Kellam JF, Vrahas M (eds). Fractures of the pelvis and acetabulum: principles and
methods of management. 4th ed. New York: Thieme; 2015: p. 159-74.
9. Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology 1986;160:445-51. https://doi.org/10.1148/radiology.160.2.3726125
10. Whiting PS, Auston D, Avilucea FR, Ross D, Archdeacon M, Sciadini M, et al. Negative stress examination under anesthesia reliably predicts pelvic ring union without displacement. J Orthop Trauma 2017;31:189-93.
https://doi.org/10.1097/BOT.0000000000000766
11. Collinge CA, Archdeacon MT, LeBus G. Saddle-horn injury of the pelvis. The injury, its outcomes, and associated male sexual dysfunction. J Bone Joint Surg Am 2009;91:1630-6. https://doi.org/10.2106/JBJS.H.00477
12. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification
compendium–2018. J Orthop Trauma 2018;32(1):S71-76. https://doi.org/10.1097/BOT.0000000000001066
13. Varga E, Hearn T, Powell J, Tile M. Effects of method of internal fixation of symphyseal disruptions on stability of the pelvic ring. Injury 1995;26(2):75-80. https://doi.org/10.1016/0020-1383(95)92180-i
14. Eastman JG, Krieg JC, Routt ML Jr. Early failure of symphysis pubis plating. Injury 2016;47(8):1707-12.
https://doi.org/10.1016/j.injury.2016.05.019
15. Sagi HC, Coniglione FM, Stanford JH. Examination under anesthetic for occult pelvic ring instability. J Orthop
Trauma 2011;25:529-36. https://doi.org/10.1097/BOT.0b013e31822b02ae
16. Avilucea FR, Whiting PS, Mir H. Posterior fixation of APC-2 pelvic ring injuries decreases rates of anterior plate
failure and malunion. J Bone Joint Surg Am 2016;98(11):944-51. https://doi.org/10.2106/JBJS.15.00723
17. Majeed SA. External fixation of the injured pelvis: the functional outcome. J Bone Joint Surg Br 1990;72:612-14. https://doi.org/10.1302/0301-620X.72B4.2380212
18. Matta JM, Tornetta P 3rd. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res 1996;(329):129-40. https://doi.org/10.1097/00003086-199608000-00016
19. Lefaivre KA, Slobogean GP, Valeriote J, O’Brien PJ, Macadam SA. Reporting and interpretation of the functional
outcomes after the surgical treatment of disruptions of the pelvic ring: a systematic review. J Bone Joint Surg Br
2012;94(4):549-55. https://doi.org/10.1302/0301-620X.94B4.27960
20. Harvey-Kelly KF, Kanakaris NK, Obakponovwe O, West RM, Giannoudis PV. Quality of life and sexual function
after traumatic pelvic fracture. J Orthop Trauma 2014;28:28-35. https://doi.org/10.1097/BOT.0b013e31828fc063
21. Hessmann MH, Rickert M, Hofmann A, Rommens PM, Buhl M. Outcome in pelvic ring fractures. Eur J Trauma
Emerg Surg 2010;36(2):124-30. https://doi.org/10.1007/s00068-010-1042-0
22. Vallier HA, Cureton BA, Ekstein C, Oldenburg FP, Wilber JH. Early definitive stabilization of unstable pelvis and
acetabulum fractures reduces morbidity. J Trauma 2010;69(3):677-84. https://doi.org/10.1097/TA.0b013e3181e50914
23. Suzuki T, Shindo M, Soma K, Minehara H, Nakamura K, Uchino M, et al. Long-term functional outcome after
unstable pelvic ring fracture. J Trauma 2007;63:884-8. https://doi.org/10.1097/01.ta.0000235888.90489.fc
24. Holstein JH, Pizanis A, Köhler D, Pohlemann T; Working Group Quality of Life After Pelvic Fractures. What are
predictors for patients’ quality of life after pelvic ring fractures? Clin Orthop Relat Res 2013;471:2841-5.
https://doi.org/10.1007/s11999-013-2840-y
25. Lefaivre KA, Blachut PA, Starr AJ, Slobogean GP, O’Brien PJ. Radiographic displacement in pelvic ring disruption: reliability of 3 previously described measurement techniques. J Orthop Trauma 2014;28(3):160-6.
https://doi.org/10.1097/BOT.0b013e31829efcc5