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Operative Versus Nonoperative Treatment of Stress-Positive Lateral Compression Type 1 Pelvic Ring Injuries: A
Lucas S Marchand, Justin Haller1, Lillia Steffenson1
1Department of Orthopaedics, University of Utah Department of Orthopaedic Surgery, Salt Lake City, UT.
Objectives:
To compare outcomes of operative versus nonoperative management of stress-positive lateral compression type 1 (LC1) pelvic ring injuries.
Design:
Multicenter retrospective study.
Setting:
Eight level 1 trauma centers.
Patients Selection Criteria:
Patients with minimally displaced stress-positive LC1 pelvic ring injuries (OTA/AO 61B2) treated with acute operative (≤3 days) versus nonoperative management.
Outcome Measures And Comparisons:
Propensity matching was used to compare operative versus nonoperative groups in terms of hospital length of stay (LOS), maximum feet ambulated while hospitalized, discharge to home versus a facility, unassisted ambulation at last follow-up, and mortality.
Results:
There were 224 patients included: 139 operative and 85 nonoperative. Operative versus nonoperative patients were similar in terms of age (47.0 vs. 59.0, P = 0.06), female gender (61.2% vs. 68.2%, P = 0.32), and follow-up duration (159 vs. 122 days, P = 0.05), and were more likely to have complete sacral fractures (63.3% vs. 35.3%; P =<0.0001), and less likely to be injured in ground-level falls (17.3% vs. 32.9%; P = 0.007) and to have baseline-assisted ambulation (5.8% vs. 16.4%; P = 0.008). After matching for these differences, operative versus nonoperative patients (77 vs. 77) had a lower mortality rate (5.2% vs. 15.6%, P = 0.04), and were similar in terms of follow-up duration (134 vs. 122 days, P = 0.39), max feet ambulated while hospitalized (16.5 vs. 50.0 feet, P = 0.55), hospital length of stay (5.0 vs. 5.0 days, P = 0.39), discharging to home (68.8% vs. 71.4%, P = 0.72), and unassisted ambulation at last follow-up (76.6% vs. 62.3%, P = 0.05). Mortality was associated with older age (72 vs. 48 years, P = 0.0002), a higher CCI (3.0 vs. 1.0, P = 0.003), assisted ambulation at baseline (29.4% vs. 8.2%, P = 0.02), and ground-level falls (64.7% vs. 19.8%, P = 0.0002).
Conclusions:
On matched analysis, operative versus nonoperative management was associated with a lower mortality rate. Mortality was associated with fragility fracture characteristics suggesting that this is an at-risk population.
Level Of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
