Associated abdominal injuries do not influence quality of care in pelvic fractures-a multicenter cohort study from the German Pelvic Registry

Markus A Küper, Robert Bachmann, Götz F Wenig, Patrick Ziegler, Alexander Trulson, Inga M Trulson, Christian Minarski, Ruth Ladurner, Ulrich Stöckle, Andreas Höch, Steven C Herath, Fabian M Stuby, Working Group on Pelvic Fractures of the German Trauma Society, Markus A Küper, Robert Bachmann, Götz F Wenig, Patrick Ziegler, Alexander Trulson, Inga M Trulson, Christian Minarski, Ruth Ladurner, Ulrich Stöckle, Andreas Höch, Steven C Herath, Fabian M Stuby, Working Group on Pelvic Fractures of the German Trauma Society

Abstract

Background: Pelvic fractures are rare but serious injuries. The influence of a concomitant abdominal trauma on the time point of surgery and the quality of care regarding quality of reduction or the clinical course in pelvic injuries has not been investigated yet.

Methods: We retrospectively analyzed the prospective consecutive cohort from the multicenter German Pelvic Registry of the German Trauma Society in the years 2003-2017. Demographic, clinical, and operative parameters were recorded and compared for two groups (isolated pelvic fracture vs. combined abdominal/pelvic trauma).

Results: 16.359 patients with pelvic injuries were treated during this period. 21.6% had a concomitant abdominal trauma. The mean age was 61.4 ± 23.5 years. Comparing the two groups, patients with a combination of pelvic and abdominal trauma were significantly younger (47.3 ± 22.0 vs. 70.5 ± 20.4 years; p < 0.001). Both, complication (21.9% vs. 9.9%; p < 0.001) and mortality (8.0% vs. 1.9%; p < 0.001) rates, were significantly higher.In the subgroup of acetabular fractures, the operation time was significantly longer in the group with the combined injury (198 ± 104 vs. 176 ± 81 min, p = 0.001). The grade of successful anatomic reduction of the acetabular fracture did not differ between the two groups.

Conclusion: Patients with a pelvic injury have a concomitant abdominal trauma in about 20% of the cases. The clinical course is significantly prolonged in patients with a combined injury, with increased rates of morbidity and mortality. However, the quality of the reduction in the subgroup of acetabular fractures is not influenced by a concomitant abdominal injury.

Trial registration: ClinicalTrials.gov, NCT03952026, Registered 16 May 2019, retrospectively registered.

Keywords: Abdominal trauma; Acetabular fracture; Pelvic ring fracture; Pelvic trauma; Postoperative reduction; Registry study.

Conflict of interest statement

Competing interestsNot applicable

© The Author(s). 2020.

Figures

Fig. 1
Fig. 1
Study protocol from the German Pelvic Registry. Group A consists of patients with an isolated pelvic fracture. Group B consists of patients with a combined pelvic fracture and abdominal injury. The remaining 4.296 patients were excluded from the study. The abdominal injury was defined as an AIS (Abdomen) > 0
Fig. 2
Fig. 2
Study protocol for the acetabular fractures from the German Pelvic Registry. Group C consists of patients with an isolated acetabular fracture. Group D consists of patients with a combined acetabular fracture and an abdominal injury. The remaining 14.006 patients were excluded from the study. The abdominal injury was defined as an AIS (Abdomen) > 0

References

    1. Andrich S, Haastert B, Neuhaus E, et al. Epidemiology of pelvic fractures in Germany: considerably high incidence rates among older people. PLoS One. 2015;10:e0139078. doi: 10.1371/journal.pone.0139078.
    1. Hauschild O, Strohm PC, Culemann U, et al. Mortality in patients with pelvic fractures: results from the German pelvic injury register. J Trauma. 2008;64:449–455. doi: 10.1097/TA.0b013e31815982b1.
    1. Arvieux C, Thony F, Broux C, et al. Current management of severe pelvic and perineal trauma. J Visc Surg. 2012;149:e227–e238. doi: 10.1016/j.jviscsurg.2012.06.004.
    1. Gad MA, Saber A, Farrag S, et al. Incidence, patterns, and factors predicting mortality of abdominal injuries in trauma patients. N Am J Med Sci. 2012;4:129–134. doi: 10.4103/1947-2714.93889.
    1. Ferrah N, Cameron P, Gabbe B, et al. Trends in the nature and management of serious abdominal trauma. World J Surg. 2019;43:1216–1225. doi: 10.1007/s00268-018-04899-4.
    1. Lee CH, Hsu CC, Huang PY. Biomechanical study of different fixation techniques for the treatment of sacroiliac joint injuries using finite element analyses and biomechanical tests. Comput Biol Med. 2017;87:250–257. doi: 10.1016/j.compbiomed.2017.06.007.
    1. Giráldez-Sánchez MA, Lázaro-Gonzálvez Á, Martínez-Reina J, et al. Percutaneous iliosacral fixation in external rotational pelvic fractures. A biomechanical analysis. Injury. 2015;46:327–332. doi: 10.1016/j.injury.2014.10.058.
    1. Rommens PM, Wagner D, Hofmann A. Minimal invasive surgical treatment of fragility fractures of the pelvis. Chirurgia (Bucur) 2017;112:524–537. doi: 10.21614/chirurgia.112.5.524.
    1. Madhu R, Kotnis R, Al-Mousawi A, et al. Outcome of surgery for reconstruction of fractures of the acetabulum. The time dependent effect of delay. J Bone Joint Surg Br. 2006;88:1197–1203. doi: 10.1302/0301-620X.88B9.17588.
    1. Matta JM, Mehne DK, Roffi R. Fractures of the acetabulum. Early results of a prospective study. Clin Orthop Relat Res. 1986;205:241–250.
    1. Rollmann MF, Holstein JH, Pohlemann T, et al. Predictors for secondary hip osteoarthritis after acetabular fractures-a pelvic registry study. Int Orthop. 2019;43:2167–2173. doi: 10.1007/s00264-018-4169-3.
    1. Swaid F, Peleg K, Alfici R, et al. A comparison study of pelvic fractures and associated abdominal injuries between pediatric and adult blunt trauma patients. J Pediatr Surg. 2017;52:386–389. doi: 10.1016/j.jpedsurg.2016.09.055.
    1. Phruetthiphat OA, Willey M, Karam MD, et al. Comparison of outcomes and complications of isolated acetabular fractures and acetabular fractures with associated injuries. J Orthop Trauma. 2017;31:31–36. doi: 10.1097/BOT.0000000000000720.
    1. Navarro S, Montmany S, Rebasa P, et al. Impact of ATLS training on preventable and potentially preventable deaths. World J Surg. 2014;38:2273–2278. doi: 10.1007/s00268-014-2587-y.
    1. Weber DG, Bendinelli C, Balogh ZJ. Damage control surgery for abdominal emergencies. Br J Surg. 2014;101:e109–e118. doi: 10.1002/bjs.9360.
    1. D'Alleyrand JC, O'Toole RV. The evolution of damage control orthopedics: current evidence and practical applications of early appropriate care. Orthop Clin North Am. 2013;44:499–507. doi: 10.1016/j.ocl.2013.06.004.
    1. Holstein JH, Stuby FM, Herath SC, et al. Influence of the pelvic trauma registry of the DGU on treatment of pelvic ring fractures. Unfallchirurg. 2016;119:475–481. doi: 10.1007/s00113-016-0168-2.
    1. Coccolini F, Stahel PF, Montori G, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg. 2017;12:5. doi: 10.1186/s13017-017-0117-6.
    1. Katsoulis E, Giannoudis PV. Impact of timing of pelvic fixation on functional outcome. Injury. 2006;37:1133–1142. doi: 10.1016/j.injury.2006.07.017.
    1. Blackmore CC, Jurkovich GJ, Linnau KF, et al. Assessment of volume of hemorrhage and outcome from pelvic fracture. Arch Surg. 2003;138:504–509. doi: 10.1001/archsurg.138.5.504.
    1. Gaski IA, Barckman J, Naess PA, et al. Reduced need for extraperitoneal pelvic packing for severe pelvic fractures is associated with improved resuscitation strategies. J Trauma Acute Care Surg. 2016;81:644–651. doi: 10.1097/TA.0000000000001139.
    1. Holstein JH, Culemann U, Pohlemann T. What are predictors of mortality in patients with pelvic fractures? Clin Orthop Relat Res. 2012;470:2090–2097. doi: 10.1007/s11999-012-2276-9.
    1. Black SR, Sathy AK, Jo C, et al. Improved Survival after pelvic fracture: 13-year experience at a single trauma center using a multidisciplinary institutional protocol. J Orthop Trauma. 2016;30:22–28. doi: 10.1097/BOT.0000000000000443.
    1. Borgman MA, Spinella PC, Perkins JG, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63:805–813. doi: 10.1097/TA.0b013e3181271ba3.
    1. Holcomb JB, Wade CE, Michalek JE, et al. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg. 2008;248:447–458.
    1. Holcomb JB, Tilley BC, Baraniuk S, et al. A transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313:471–482. doi: 10.1001/jama.2015.12.
    1. Schweigkofler U, Wohlrath B, Trentsch H, et al. Diagnostics and early treatment in prehospital and emergency-room phase in suspicious pelvic ring fractures. Eur J Trauma Emerg Surg. 2018;44:747–752. doi: 10.1007/s00068-017-0860-0.
    1. Eastridge BJ, Starr A, Minei JP, et al. The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions. J Trauma. 2002;53:446–451. doi: 10.1097/00005373-200209000-00009.
    1. Marzi I, Lustenberger T. Management of bleeding pelvic fractures. Scand J Surg. 2014;103:104–111. doi: 10.1177/1457496914525604.
    1. Niola R, Pinto A, Sparano A, et al. Arterial bleeding in pelvic trauma: priorities in angiographic embolization. Curr Probl Diagn Radiol. 2012;41:93–101. doi: 10.1067/j.cpradiol.2011.07.008.
    1. Perkins ZB, Maytham GD, Koers L, et al. Impact on outcome of a targeted performance improvement programme in haemodynamically unstable patients with a pelvic fracture. Bone Joint J. 2014;96-B:1090–1097. doi: 10.1302/0301-620X.96B8.33383.
    1. White CE, Hsu JR, Holcomb JB. Haemodynamically unstable pelvic fractures. Injury. 2009;40:1023–1030. doi: 10.1016/j.injury.2008.11.023.
    1. Vallier HA, Cureton BA, Ekstein C, et al. Early definitive stabilization of unstable pelvis and acetabulum fractures reduces morbidity. J Trauma. 2010;69:677–684. doi: 10.1097/TA.0b013e3181e50914.
    1. Vallier HA, Dolenc AJ, Moore TA. Early appropriate care: a protocol to standardize resuscitation assessment and to expedite fracture care reduces hospital stay and enhances revenue. J Orthop Trauma. 2016;30:306–311.
    1. Glass NE, Burlew CC, Hahnhaussen J, et al. Early definitive fracture fixation is safely performed in the presence of an open abdomen in multiply injured patients. J Orthop Trauma. 2017;31:624–630. doi: 10.1097/BOT.0000000000000959.
    1. Demetriades D, Karaiskakis M, Velmahos GC, et al. Pelvic fractures in pediatric and adult trauma patients: are they different injuries? J Trauma. 2003;54:1146–1151. doi: 10.1097/01.TA.0000044352.00377.8F.
    1. Demetriades D, Karaiskakis M, Toutouzas C, et al. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg. 2002;195:1–10. doi: 10.1016/S1072-7515(02)01197-3.
    1. Chawda MN, Hildebrand F, Pape HC, et al. Predicting outcome after multiple trauma: which scoring system? Injury. 2004;35:347–358. doi: 10.1016/S0020-1383(03)00140-2.

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