An international survey of pelvic trauma surgeons on the management of pelvic ring injuries |
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| Affiliation: | 1. Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO;2. Department of Orthopaedic Surgery, University of Texas at Southwestern, Dallas, Texas;3. Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri;4. Department of Orthopaedic Surgery, University of Munich at Hannover Medical School, Hannover, Germany;5. Department of Orthopaedic Surgery, Dignity Health Medical Group, Phoenix, Arizona;6. Department of Orthopaedic Surgery, Harboview Medical Center, University of Washington, Seattle, Washington;7. Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio;8. Department of Orthopaedic Surgery, University of California Davis, Sacramento, California;9. Department of Orthopaedic Surgery, Orlando Regional Medical Center, Orlando, Florida;10. Department of Orthopaedic Surgery, Aurelia Hospital, Roma, Italy;11. Department of Orthopaedic Surgery, Tulane University, New Orleans, Louisiana;12. Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota;13. Department of Orthopaedic Surgery, University of Leeds, Leeds, United Kingdom;14. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, SC Korea;15. Department of Orthopaedic Surgery, Swedish Medical Center, Englewood, Colorado;p. Department of Orthopaedic Surgery, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil;q. Department of Orthopaedic Surgery, All India Institute of Medical Sciences, South Delhi, India;1. Royal Melbourne Hospital – Orthopedic Department, Grattan Street, Melbourne 3050, Australia;2. Dip. Sport Med; Clinical Professor in Orthopaedics, Department of Surgery, Cumming School of Medicine; Adjunct Professor Faculty of Kinesiology; Medical Director Sport Medicine Centre, University of Calgary, Alberta, Canada;3. Clinical Professor in Orthopedics, Department of Surgery, Cumming School of Medicine, University of Calgary, 0490 McCaig Tower, 3134 Hospital Drive NW, Foothills Hospital, Calgary, Alberta, Canada;1. Department of Orthopaedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea;2. Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea;3. Department of Orthopaedic Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea;4. Department of Orthopaedic Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea;5. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea;6. Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505,Republic of Korea;1. Department of Orthopaedic Surgery University of California San Diego, USA;2. Department of Orthopaedic Surgery University of California Davis, USA |
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| Abstract: | IntroductionThere exists substantial variability in the management of pelvic ring injuries among pelvic trauma surgeons. The objective of this study was to perform a comprehensive survey on the management of pelvic ring injuries among an international group of pelvic trauma surgeons to determine areas of agreement and disagreement.MethodsA 45-item questionnaire was developed using an online survey platform and distributed to 30 international pelvic trauma surgeons. The survey consisted of general questions on the acute management of pelvic ring injuries and questions regarding 5 cases: Lateral compression (LC) type 1 injury, LC-3, Anterior-posterior compression (APC) type 3 injury, a combined vertical shear (VS) injury through the sacrum, and VS injury through sacroiliac joint. Respondents were shown blinded anteroposterior pelvis radiographs and axial computed tomography (CT) images for each case and asked if the injury needed fixation, the type of fixation, the order of fixation, and postoperative weight-bearing status. The Kappa statistic was calculated to assess agreement between respondents for each question.ResultsNineteen out of 30 pelvic trauma surgeons completed the survey. Respondents practiced in Brazil (n = 1), Germany (n = 1), India (n = 1), Italy (n = 1) United Kingdom (n = 1), and the United States (n = 14). Of the 45 questions in this survey, 38 (84%) had minimal to no agreement among the respondents. There was moderate agreement, for performing lumbopelvic fixation when indicated, for anterior and posterior fixation of the LC-3 injury, and on forgoing EUA or stress X-rays for the APC-3 injury. There was strong agreement for open reduction and internal fixation of the anterior pelvic ring in the APC-3 injury and the VS injury through the SI joint. In contrast, LC-1 injury and combined VS pelvic ring injury through the sacrum had no areas of moderate to strong agreement.DiscussionThis study identified specific areas of pelvic ring injury management with minimal to no agreement among pelvic trauma surgeons. Future research should target these areas with a lack of agreement to decrease practice variability and improve patient outcomes. |
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