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Anterior Pelvic Ring Fracture Pattern Predicts Subsequent Displacement in Lateral Compression Sacral Fractures.

Jonathan D Ellis1, Nihar S Shah, Michael T Archdeacon

  • 1Department of Orthopaedic Surgery, Division of Trauma, University of Cincinnati Medical Center, Cincinnati, OH.

Journal of Orthopaedic Trauma
|May 18, 2022
PubMed
Summary

Anterior pelvic fracture patterns, specifically comminuted or oblique pubic rami fractures, strongly correlate with displacement in lateral compression sacral fractures. Transverse pubic ramus fractures indicate stability, suggesting nonoperative management is successful.

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Area of Science:

  • Orthopedic surgery
  • Trauma radiology
  • Pelvic fracture biomechanics

Background:

  • Lateral compression (LC) sacral fractures can be associated with anterior pelvic ring injuries.
  • Predicting displacement in these complex injuries is crucial for appropriate management.

Purpose of the Study:

  • To investigate the correlation between anterior pelvic fracture patterns and subsequent displacement in patients with lateral compression sacral fractures.
  • To assess the influence of anterior fracture patterns on outcomes in both nonoperative and operative treatment strategies.

Main Methods:

  • Retrospective cohort study of 227 skeletally mature patients with traumatic LC pelvic ring injuries.
  • Analysis of anterior pelvic ring fracture patterns, including comminuted, oblique, and transverse pubic rami fractures.
  • Radiographic assessment for displacement on examination under anesthesia (EUA) and follow-up.

Main Results:

  • Comminuted or oblique ipsilateral superior and inferior pubic rami fractures strongly correlated with displacement (95.6% and 100%, respectively) regardless of sacral fracture pattern.
  • Patients with transverse or absent inferior pubic ramus fractures showed no displacement (0%).
  • Posterior-only fixation failed in all patients (100%) with comminuted/oblique rami fractures, indicating a need for anterior fixation.

Conclusions:

  • Unstable anterior pelvic fractures (comminuted/oblique pubic rami) predict displacement in LC sacral fractures.
  • Examination under anesthesia is recommended for occult instability detection.
  • Posterior-only fixation is insufficient for unstable anterior patterns; supplemental anterior fixation should be considered.