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Observational Study
. 2019 May 15;20(1):217.
doi: 10.1186/s12891-019-2583-3.

Decision-making, therapy, and outcome in lateral compression fractures of the pelvis - analysis of a single center treatment

J Zwingmann  1 , H Eberbach  1 , P C Strohm  1   2 , N P Südkamp  1 , J Lauritsen  3 , H Schmal  4   5
Affiliations
Observational Study

Decision-making, therapy, and outcome in lateral compression fractures of the pelvis - analysis of a single center treatment

J Zwingmann et al. BMC Musculoskelet Disord. .

Abstract

Background: Pelvic lateral compression fractures are the most stable of the unstable fractures. Therefore, decision making regarding operative or non-operative therapy is still a matter of debate.

Methods: Factors, influencing decision making for therapy, were explored based on prospectively collected register data of a single Level-1 trauma center. The analysis included epidemiological records such as age and gender, and injury characterizing parameters such as degree of displacement and the Injury Severity Score (ISS). In-hospital mortality and complications served as short-term outcome variables. After matching for relevant confounders, long-term results were compared between operatively and non-operatively treated patients, evaluating the Merle d'Aubigne and the EQ. 5D-3 L scores.

Results: Over an 11-year period (2004-14), 134 patients suffered from lateral compression fractures out of 567 pelvic fractures (33%). After excluding patients with clear indications for operation (complex pelvic fractures and pubic symphysis ruptures) and pediatric fractures, 114 patients could be included in the analysis. Sixty-one patients were treated conservatively (54%), 53 with an operation (46%). The operated patients were younger (43.7 vs 58.3 years), had higher ISS (19.9 vs 15.5 points) and fracture displacements (2.3 vs 4.9 mm) (p < 0.001 for all). The length of hospital stay was shorter in the conservatively treated group (12.7 vs 17.3 days, p < 0.02). Although the types of complications were different, the incidence was not. The mortality was less in the operated group (1.9% vs. 6.6%), however, a logistic regression analysis showed that only the ISS was an independent risk factor, but not the type of therapy. Merle d'Aubigne and EQ. 5D-3 L scores were not different in the matched cohorts.

Conclusion: Decision-making for operative therapy was favored in severely injured young patients with high displacement. However, short- and long-term outcomes showed no difference between operatively and non-operatively treated patients.

Trial registration: DRKS, no. 00000488 . Registered 14th July 2010 - Retrospectively registered.

Keywords: Follow-up; Lateral compression; Logistic regression; Non-operative; Operative; Pelvic fracture; Register; Treatment.

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Conflict of interest statement

Ethics approval and consent to participate

Data acquisition and analysis were done in accordance with ethical guidelines and approved by our institutional review board of the University of Freiburg (no. 89/09). Patients provided their written consent for participation. The trial was registered at the German Clinical Trials Register (no. 00000488), which also includes the follow-up.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient selection
Fig. 2
Fig. 2
Clinical example for non-operative therapy of a lateral compression fracture. a shows the initial CT-scanning with sacral fractures on both sides. b shows the pubic rami fractures and the coils after embolization. c shows consolidation after 6 weeks. The patient presented with full weight bearing and without pain
Fig. 3
Fig. 3
Clinical example for operative therapy of a lateral compression fracture. a and b show the initial CT-scanning with a sacral fracture on the right side. c shows the fixed situation after implantation of an ilio-sacral screw and anterior external fixation. d shows consolidation after implant removal 6 months following injury. The patient presented with full weight bearing and without pain
See this image and copyright information in PMC

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