OTA 2006 Posters
Scientific Poster #62 Pelvis
Combined Pelvic Ring Disruption and Acetabulum Fracture: Description
of Associated Injury Patterns in 40 Patients
Greg M. Osgood, MD1 (n); Theodore Manson, MD2
(n);
Robert V. O'Toole, MD1 (n); Clifford Turen, MD1 (n);
1R. Adams Cowley Shock Trauma Center, Department of Orthopaedic
Surgery, University of Maryland Medical School, Baltimore, Maryland, USA;
2Department of Orthopaedic Surgery, Johns Hopkins Medical School,
Baltimore Maryland, USA
Purpose: Combined pelvic ring disruptions and acetabulum fractures
are uncommon injuries, even at Level 1 trauma centers. This study was conducted
to evaluate the pattern of acetabulum fractures and pelvic ring disruptions
that occur together, and to compare this to the injury patterns that have
been observed historically for each injury in isolation.
Methods: Between December 1997 and December 2001, 457 isolated acetabulum
fractures, 854 isolated pelvic ring disruptions, and 40 combined injuries
were evaluated at a Level 1 trauma center. A retrospective review of prospective
databases yielded 40 patients with combined injuries comprising 44 acetabulum
fractures with pelvic ring disruption. Injuries were classified according
to Letournel
and Young-Burgess
by the senior author. Elementary acetabulum fractures included one anterior
wall, 8 anterior column, 2 posterior wall (PW), and 9 transverse fractures.
Associated acetabulum fractures included 3 transverse with associated PW,
5 anterior column-posterior hemitransverse, 10 T-type, and 6 associated
both-column fractures. There were 21 anterior-posterior compression (APC)
pelvic ring injuries, 17 lateral compression (LC) injuries, and one vertical
shear injury. Fracture patterns were compared to isolated injury patterns
at this institution and to Letournel's large acetabulum fracture series.
Results: The mean Injury Severity Score (ISS) for this cohort was
27.9. This patient series included 4.5% PW fractures, which is markedly
less than 30% isolated PW fractures at this institution and 24% published
by Letournel (P <0.003, Fisher Exact). There were no posterior
column fractures or posterior column with associated PW fractures. 73% of
acetabulum fractures in this study involved both anterior and posterior
columns. There appears to be no predominant acetabulum fracture type in
combined pelvic injuries; however, 53% of study patients sustained APC pelvic
ring disruptions, exceeding this center's norm of 19% (P <0.001).
Overall mortality was 12.5%. Early death was seen in 19% of combined APC
injuries, and in 6% of LC injuries.
Conclusion/Significance: This study presents the largest cohort of
combined pelvic ring disruptions and acetabulum fractures to date. This
population is severely traumatized, with high ISS. Isolated posterior acetabulum
fractures are uncommon in these patients. APC pelvic injuries occur frequently
and are associated with high mortality.
If noted, the author indicates something of value received.
The codes are identified as a-research or institutional support; b-miscellaneous
funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts
disclosed, and *disclosure not available at time of printing.
·
The FDA has not cleared this drug and/or medical device for the use
described in this presentation (i.e., the drug or medical device is being
discussed for an "off label" use). · · FDA
information not available at time of printing.