Sat., 10/16/10 Pelvis & Spine, Paper #77, 3:30 pm OTA-2010
Defining the Role of Examination Under Anesthetic in Determining the Need for Surgical Stabilization after Traumatic Pelvic Ring Injuries
H. Claude Sagi, MD; Franco M. Coniglione, DO; Jason H. Stanford, DO;
Orthopedic Trauma Service, Tampa General Hospital, Tampa, Florida, USA
Purpose: This study was undertaken to describe the technique and results of stress examination of pelvic ring injuries using fluoroscopy under anesthesia to determine stability and the need for fixation.
Methods: Pelvic ring injuries that were classified as having “incomplete” disruption of the posterior pelvic ring (OTA 61-B) on plain radiographs and CT were included in this analysis. All patients were anesthetized and placed in the supine position for stress examination of the pelvic ring consisting of internal rotation, external rotation, and push-pull of the lower extremities. Fluoroscopic imaging using AP, inlet, and outlet projections for each manipulative maneuver as described above was performed. The classification of the pelvic ring injury was then further defined by the amount of rotational instability in the axial and sagittal planes and translational instability in the coronal plane. The decision to proceed with anterior and/or posterior operative stabilization was based on the suspected degree of pelvic ring instability from the results of the examination under anesthesia (EUA).
Results: 70 patients underwent EUA of their pelvic ring injuries by the senior author; 52 males and 18 females, with an average age of 35 years, comprised the study group. In all, 39 anterior-posterior compression (APC or OTA 61-B1) injuries and 31 lateral compression (LC or OTA 61-B2) injuries were evaluated. Of the 14 pelvic ring injuries initially classified as APC-1, 7 (50%) were deemed stable and treated nonsurgically, while the other 7 were felt to have sufficient instability requiring fixation based on EUA. Of the 23 injuries initially classified as APC-2, all but 1 required surgical fixation; 13 (57%) had anterior fixation alone, while 9 (39%) required anterior fixation with supplemental iliosacral screw placement based on EUA. Of the 19 injuries initially classified as LC-1, 12 (63%) were stable and treated nonsurgically, while 7 (37%) required surgical stabilization based on EUA. Of the 8 LC-2 injuries, 3 (38%) were treated nonoperatively, and 5 (63%) required stabilization. Of the 4 LC-3 injuries examined, all required surgical stabilization.
Conclusions: Static radiographs and CT of the pelvis inadequately define the full extent of instability with traumatic injuries to the pelvic ring. The high incidence of poor functional outcomes associated with pelvic fracture may be due, in part, to inadequate treatment of misdiagnosed injuries. Performing an EUA with fluoroscopy as described in this series revealed undiagnosed instability in 50% of presumed APC-1 injuries, 39% of APC-2 injuries, and 37% of LC-1 injuries. We conclude that pelvic EUA is an important diagnostic tool that can provide additional information regarding stability or instability of the pelvic ring that can help guide treatment and determine the need for surgical stabilization.
Alphabetical Disclosure Listing (292K PDF)
• 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. Δ OTA Grant.