Does sequential examination under anaesthesia provide a reliable method to determine a management plan for unstable lateral compression pelvic ring injuries? a prospective study

Mostafa Ahmed Shawky; Ahmed Hazem Abdelazeem; Khaled Fawzy Abdel-Kader; Molham Mahmood Mohammad; Ahmad Hamdi Azzam

doi:10.1007/s00590-023-03625-8

Does sequential examination under anaesthesia provide a reliable method to determine a management plan for unstable lateral compression pelvic ring injuries? a prospective study

Eur J Orthop Surg Traumatol. 2023 Jul 5. doi: 10.1007/s00590-023-03625-8. Online ahead of print.

Authors

Mostafa Ahmed Shawky¹, Ahmed Hazem Abdelazeem², Khaled Fawzy Abdel-Kader², Molham Mahmood Mohammad², Ahmad Hamdi Azzam²

Affiliations

¹ Pelvic Trauma and Arthroplasty Unit, Department of Orthopaedics and Traumatology, Kasr-AlAiny Hospital, Cairo University, 12 Al-Saraya Street, El Manial, Cairo, Egypt. mostafa.a.shawky.mohamed@gmail.com.
² Pelvic Trauma and Arthroplasty Unit, Department of Orthopaedics and Traumatology, Kasr-AlAiny Hospital, Cairo University, 12 Al-Saraya Street, El Manial, Cairo, Egypt.

PMID: 37407719
DOI: 10.1007/s00590-023-03625-8

Abstract

Purpose: To assess the reliability of sequential examination under anaesthesia (EUA) to determine pelvic instability and to evaluate radiological and functional outcomes in unstable lateral compression (LC) injuries.

Methods: A prospective case series study was conducted from 2020 to 2022 at a university hospital on 43 cases with LC injuries that met the inclusion criteria. Sequential EUA was carried out in three steps. Posterior-only fixation or anterior-posterior fixation was done according to the algorithm. Each patient was followed up for at least 12 months, both radiologically and functionally.

Results: Forty cases proved unstable and were fixed. None showed secondary displacement in the anterior-posterior fixation group. However, five cases (19.2%) of the posterior-only fixation group showed secondary displacement with a mean of 5.9 mm. Four cases of them had tetra-ramic injuries. There is a high tendency for secondary displacement at 14.5 mm or more preoperative displacement of the rami. Patients with secondary displacement showed comparable functional outcome scores to patients without secondary displacement. Posterior-only fixation showed shorter operative time, lesser radiological exposure, blood loss and iatrogenic nerve injury than anterior-posterior fixation.

Conclusion: EUA is a reliable method to determine pelvic instability and management plan for LC fractures with unilateral anterior ring injury. Anterior-posterior fixation is needed if there is a tetra-ramic fracture or initial anterior ring displacement of 14.5 mm or more, irrespective of EUA.

Keywords: Anterior–posterior fixation; Examination under anaesthesia; Fracture pelvis; Lateral compression injuries; Pelvic injuries; Posterior-only fixation.