Acute Pelvic Fractures: I. Causation and Classification.

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Abstract

7. Int Orthop. 2023 Sep;47(9):2301-2318. doi: 10.1007/s00264-023-05859-x. Epub 2023 Jun 17. Standard practice in the treatment of unstable pelvic ring injuries: an international survey. Klingebiel FK(#)(1)(2), Hasegawa M(#)(3), Parry J(4), Balogh ZJ(5), Sen RK(6), Kalbas Y(7)(8), Teuben M(7)(8), Halvachizadeh S(7)(8), Pape HC(7)(8), Pfeifer R(7)(8); SICOT Trauma Research Group. Collaborators: Al-Rouk TB, Balogh ZJ, Ganse B, Hanschen M, Hasani I, Klingebiel FK, Korobushkin G, Kumabe Y, McCaul J, Parry JA, Rashed M, Saveski J, Sharma H, Zarti M, Pfeifer R, Zelle BA. Author information: (1)Department of Traumatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. felixkarl-ludwig.klingebiel@usz.ch. (2)Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland. felixkarl-ludwig.klingebiel@usz.ch. (3)Division of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA. (4)Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA. (5)Department of Traumatology, John Hunter Hospital, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, Australia. (6)Department of Orthopaedics, Max Hospital, Mohali, India. (7)Department of Traumatology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. (8)Department of Surgical Research, Harald Tscherne Laboratory for Orthopaedic and Trauma Research, Zurich University Hospital, Zurich, Switzerland. (#)Contributed equally PURPOSE: Unstable pelvic ring injury can result in a life-threatening situation and lead to long-term disability. Established classification systems, recently emerged resuscitative and treatment options as well as techniques, have facilitated expansion in how these injuries can be studied and managed. This study aims to access practice variation in the management of unstable pelvic injuries around the globe. METHODS: A standardized questionnaire including 15 questions was developed by experts from the SICOT trauma committee (Société Internationale de Chirurgie Orthopédique et de Traumatologie) and then distributed among members. The survey was conducted online for one month in 2022 with 358 trauma surgeons, encompassing responses from 80 countries (experience > 5 years = 79%). Topics in the questionnaire included surgical and interventional treatment strategies, classification, staging/reconstruction procedures, and preoperative imaging. Answer options for treatment strategies were ranked on a 4-point rating scale with following options: (1) always (A), (2) often (O), (3) seldom (S), and (4) never (N). Stratification was performed according to geographic regions (continents). RESULTS: The Young and Burgess (52%) and Tile/AO (47%) classification systems were commonly used. Preoperative three-dimensional (3D) computed tomography (CT) scans were utilized by 93% of respondents. Rescue screws (RS), C-clamps (CC), angioembolization (AE), and pelvic packing (PP) were observed to be rarely implemented in practice (A + O: RS = 24%, CC = 25%, AE = 21%, PP = 25%). External fixation was the most common method temporized fixation (A + O = 71%). Percutaneous screw fixation was the most common definitive fixation technique (A + O = 57%). In contrast, 3D navigation techniques were rarely utilized (A + O = 15%). Most standards in treatment of unstable pelvic ring injuries are implemented equally across the globe. The greatest differences were observed in augmented techniques to bleeding control, such as angioembolization and REBOA, more commonly used in Europe (both), North America (both), and Oceania (only angioembolization). CONCLUSION: The Young-Burgess and Tile/AO classifications are used approximately equally across the world. Initial non-invasive stabilization with binders and temporary external fixation are commonly utilized, while specific haemorrhage control techniques such as pelvic packing and angioembolization are rarely and REBOA almost never considered. The substantial regional differences' impact on outcomes needs to be further explored. © 2023. The Author(s). DOI: 10.1007/s00264-023-05859-x PMCID: PMC10439026