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Sacral Fracture Completeness in Lateral Compression Type 1 Pelvic Ring Injuries Has Weak Interobserver Reliability.

Michael Hadeed1, Katya Strage, Austin Heare

  • 1Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO.

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|April 20, 2021
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Summary

Orthopaedic trauma surgeons showed weak agreement on sacral fracture completeness in pelvic injuries. This challenges using fracture completeness to rule out occult instability.

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Area of Science:

  • Orthopaedic Surgery
  • Trauma Surgery
  • Radiology

Background:

  • Minimally displaced lateral compression type 1 pelvic ring injuries can present with occult instability.
  • Evaluating sacral fracture completeness is crucial for determining treatment and prognosis.

Purpose of the Study:

  • To assess the interobserver reliability among fellowship-trained orthopaedic trauma surgeons in determining sacral fracture completeness.
  • To evaluate the correlation between sacral fracture completeness and occult instability in pelvic ring injuries.

Main Methods:

  • A survey study involving 10 fellowship-trained orthopaedic trauma surgeons.
  • Surgeons reviewed axial computed tomography (CT) images of the sacrum from 10 cases of minimally displaced lateral compression type 1 pelvic injuries with proven occult instability.
  • Participants determined whether sacral fractures were complete or incomplete.

Main Results:

  • Interobserver reliability for sacral fracture completeness was weak (k = 0.46).
  • Complete sacral fractures showed variable agreement among surgeons (40%-90%), with no 100% consensus in any case.
  • Incomplete sacral fractures demonstrated 100% agreement among surgeons in 4 out of 5 cases.

Conclusions:

  • There is weak interobserver reliability in assessing sacral fracture completeness among orthopaedic trauma surgeons.
  • Sacral fractures deemed incomplete by all surgeons were associated with occult instability.
  • Sacral fracture completeness should not be solely relied upon to exclude occult instability in these injuries.