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      Pelvic ring fractures: what about timing?

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          Abstract

          Background and aim: Pelvic ring fractures represent a challenge for orthopaedic surgeon. Their management depends on patient’s condition, pattern of fracture and associated injuries. Optimal timing for synthesis is not yet clear. The aim of this study was to define if surgical timing influenced clinic and radiographic outcomes following open reduction and internal fixation for Tile B and C fractures. Materials and methods: 38 patients were included. Patients underwent a clinical examination with the Majeed Score, Iowa Pelvic Score and Orlando Pelvic Score. The radiographic assessment was performed according to Matta Pelvic Score. A statistical analysis of the data compared patients who were operated within 3 weeks (group 1) and those operated later (group 2). Results: Both clinical and radiological outcomes were influenced by timing of surgery. Conclusion: Pelvic ring fractures interest many polytrauma patients and, therefore, their surgical orthopedic approach is frequently delayed as consequence of the severity of the associated clinical conditions. An early surgery of pelvic rong fractures allows a better quality of reduction and osteosynthesis. (www.actabiomedica.it)

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          Most cited references23

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          Grading the outcome of pelvic fractures.

          S A Majeed (1989)
          A system for assessment of function after major pelvic injuries is proposed. This numerical system developed from a five-year prospective study of 60 patients. Five factors were assessed and scored: pain, standing, sitting, sexual intercourse and work performance. The total score then gave a clinical grade as excellent, good, fair or poor. The scoring system allows comparison between early and late results and also between various methods of treatment.
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            The epidemiology of pelvic ring fractures: a population-based study.

            The severity of pelvic ring fractures (PRFs) can range from minor injury with low-energy mechanism to high-energy injury causing prehospital death. The purpose of this study was to prospectively describe the comprehensive pelvic fracture occurrence in an inclusive trauma system. A 12-month prospective, population-based epidemiologic study was performed in the Hunter Region, New South Wales, Australia (population of 600,000, served by one Level I trauma center and 7 referring hospitals). Patient demographics, mechanism, injury severity, shock parameters, and outcomes were recorded prospectively. The database included all pelvic fractures from the region: high-energy pelvic fractures (HE-PRFs), low-energy pelvic fractures (LE-PRFs), and prehospital deaths (PD-PRFs). The incidence of PRF in the trauma system was 23 per 100,000 persons (138 fractures). The incidences of HE-PRF and LE-PRF were each 10 per 100,000 persons, whereas there were 3 PD-PRFs per 100,000. HE-PRF compared with LE-PRF occurred predominantly in men (64% vs. 20%, p < 0.05), younger persons (41 +/- 3 vs. 83 +/- 1 years, p < 0.05), those who had a higher Injury Severity Score (23 +/- 3 vs. 6 +/- 1, p < 0.05), and those with lower blood pressure (111 +/- 1 mm Hg vs. 153 +/- 1 mm Hg, p < 0.05), but the inhospital mortality rate was not statistically different (15% vs. 8%, p = NS). The overall mortality of the cohort was 23% (60% of those were from the PD-PRF group). The PRF-related mortality was 7% (HE-PRF: 7%; LE-PRF: 2%; PD-PRF: 33%), which was always attributable to bleeding. The incidence of demonstrated pelvic fracture-related arterial bleeding was 1.3 per 100,000 persons per year. LE-PRF and HE-PRF are equally frequent among hospital admissions. They represent two distinct demographic groups with similar mortality rate. Most PRF-related deaths occur prehospitally. Bleeding remains the primary cause of PRF-related mortality in all groups.
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              Mortality in patients with pelvic fractures: results from the German pelvic injury register.

              Pelvic and acetabular fractures are rare injuries and account for approximately 3% to 8% of all fractures. Often the result of high energy blunt trauma, most of the patients sustaining pelvic injuries are at high risk of associated injuries strongly influencing outcome and survival rates. Because of anatomic differences it has been suggested that pediatric pelvic fractures are different injuries as compared with that of adults. However, this has been controversially discussed. Aim of this multicenter register study was to identify similarities and differences between pediatric and adult pelvic trauma and evaluate the influence of changes in medical treatment by comparison of two treatment periods. In this multicenter register study, data of 4,291 patients treated from 1991 to 1993 (n = 1,723) or 1998 to 2000 (n = 2,568) for pelvic fractures in one of the 23 participating hospitals were evaluated for age, gender, Injury Severity Score (ISS), Hannover Polytrauma Score (PTS), fracture type (using Tile's classification), peripelvic soft tissue injury, need for emergency measures, mortality, cause of death, and need for operative stabilization. We compared the patients' characteristics of the two treatment periods and pediatric with adult pelvic injuries. Statistical analysis was performed using SAS software. There was no difference in terms of ISS, PTS, and presence of peripelvic soft tissue injuries between the two observation periods. Mortality rate dropped significantly from 7.9% to 5% (p < 0.0001) in the latter treatment period. Death was directly attributed to the pelvic injury in 11% from 1991 to 1993. This rate dropped significantly to 7% in the period from 1998 to 2000 (p = 0.020). A type fractures decreased from 61.1% (1991-1993) to 57.1% (1998-2000) of patients (p = 0.028) and except for these simple fractures there was a significant overall trend toward surgical treatment. Multivariate analysis revealed ISS, PTS, concomitant soft tissue injuries, and need for emergency measures as independent risk factors for death whereas surgical stabilization and treatment in the latter treatment period were associated with an increased survival rate. We found no difference between the adult and the pediatric group in terms of ISS and concomitant peripelvic soft tissue injuries. Children were less likely to receive surgical treatment (19.4% vs. 34.5%, p < 0.0001) but requirement for emergency measures was higher in the pediatric group (17.9% vs. 11.1%, p = 0.033). Moreover, we found no significant differences in mortality between both groups (6.1% vs. 8.2%, p = 0.28). Multivariate analysis showed age
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                Author and article information

                Journal
                Acta Biomed
                Acta Biomed
                Acta Bio Medica : Atenei Parmensis
                Mattioli 1885 (Italy )
                0392-4203
                2531-6745
                2020
                06 March 2020
                : 90
                : Suppl 12
                : 76-81
                Affiliations
                [1 ] Orthopaedics and Traumatology Clinic, Department of Medicine and Surgery, University of Parma, Parma (Italy)
                [2 ] Orthopaedics and Traumatology Unit, Department of Health Sciences, “Maggiore della Carità” Hospital, Piemonte Orientale University, Novara, Italy
                Author notes
                Correspondence: Francesco Pogliacomi Orthopaedics and Traumatology Clinic Department of Medicine and Surgery, University of Parma Via Gramsci 14 - 43126 Parma (Italy) E-mail: francesco.pogliacomi@ 123456unipr.it
                Article
                ACTA-90-76
                10.23750/abm.v90i12-S.8949
                7233695
                31821288
                8887bc30-d719-4a52-a505-d0ec2e3748a7
                Copyright: © 2019 ACTA BIO MEDICA SOCIETY OF MEDICINE AND NATURAL SCIENCES OF PARMA

                This work is licensed under a Creative Commons Attribution 4.0 International License

                History
                : 01 October 2019
                : 03 November 2019
                Categories
                Case Report

                pelvis,fracture,injury,timing,fixation,surgery
                pelvis, fracture, injury, timing, fixation, surgery

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