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Examination under anesthetic for occult pelvic ring instability.

H Claude Sagi1, Franco M Coniglione, Jason H Stanford

  • 1Orthopedic Trauma Service, Florida Orthopedic Institute, Tampa, FL 33606, USA. eversosaggy@me.com

Journal of Orthopaedic Trauma
|August 23, 2011
PubMed
Summary

Examination under anesthesia (EUA) with dynamic stress fluoroscopy accurately identifies occult instability in pelvic ring injuries. This technique refines treatment decisions, improving outcomes for patients with traumatic pelvic fractures.

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Area of Science:

  • Orthopaedic surgery
  • Trauma care
  • Diagnostic imaging

Background:

  • Pelvic ring injuries can lead to poor functional outcomes due to misdiagnosis or chronic instability.
  • Accurate assessment of pelvic ring stability is crucial for appropriate treatment and patient recovery.

Purpose of the Study:

  • To describe the technique and results of examination under anesthesia (EUA) with dynamic stress fluoroscopy for traumatic pelvic ring injuries.
  • To evaluate the utility of EUA in determining pelvic ring stability and the need for operative stabilization.

Main Methods:

  • Retrospective review of 68 skeletally mature patients with traumatic incomplete posterior pelvic ring injuries (OTA 61-B).
  • EUA performed under anesthesia with dynamic fluoroscopy, including resting and stress maneuvers (internal/external rotation, push-pull) in AP, inlet, and outlet views.
  • Preoperative classification (APC/LC) was reassessed based on intraoperative findings to guide surgical stabilization decisions.

Main Results:

  • EUA revealed occult instability in 50% of presumed APC-1, 39% of APC-2, and 37% of LC-1 injuries.
  • Treatment decisions were modified based on EUA findings, leading to anterior fixation alone (APC-2a), anterior and posterior fixation (APC-2b), or non-surgical management (LC-1a).

Conclusions:

  • EUA with dynamic stress fluoroscopy is a valuable tool for identifying occult pelvic ring instability.
  • Proposed modifications to the Young-Burgess Classification (APC-2a, APC-2b, LC-1a, LC-1b) reflect dynamic instability identified during EUA.
  • This technique aids in optimizing treatment strategies for traumatic pelvic ring injuries, potentially reducing poor functional outcomes.