Outcomes at 2 years follow-up of sacral fractures associated with unstable vertical pelvic ring injuries in obese patients: a multicentric retrospective study
Sacral fractures and pelvic injuries in obese patients
Keywords:
sacral fractures; pelvic ring fractures; vertical shear; obese patients; lumbopelvic fixation; BMI; abdominal circumference, sacral fractures; pelvic ring fractures; vertical shear; obese patients;, lumbopelvic fixation; BMI; abdominal circumference;Abstract
Background and aim: Sacral fractures with concomitant unstable pelvic ring injuries are severe conditions which occur in patients involved in high-energy trauma. When operative treatment is required, high surgical experience on the field is mandatory, especially in a sub-polpulation of obese patients which have increased risk of complications. The aim of this multicentric retroscpective study was to describe and analyze clinical and radiological outcomes of sacral vertical fractures in obese patients with a minimum of 2 years follow-up.
Methods: A total of 121 pelvic fractures admitted to Emergency Departments of three II level trauma centres from April 2015 to April 2021 were retrospectively reviewed. Demographics, injury mechanism, surgical data and complications were collected. The quality of life and the pelvic function were respectively measured by SF-12 questionnaires, Denis Work Scale and Majeed Score. The inter-rater agreement between the clinical scores and the Denis Work Scale was assessed.
Results: A total of 19 patients were included in the study. The average follow up was 41.16 months. The average BMI was 38.63 and the mean abdominal circumference was 128.10 cm. The average Majeed and SF-12 scores were respectively 66.47 and 74.32. Five patients were able to return to their previous employment. The post traumatic life's quality and related dysfunctions are influenced by the high BMI.
Conclusions: Faster recovery and early weight-bearing should be persued in order to minimize complications, expecially in obese patients. In these sample of patients, “triangular osteosynthesis" was the best treatment choice for sacral vertical fractures
References
Falzarano G, Medici A, Carta S. et al. The orthopedic damage control in pelvic ring fractures: when and why-a multicenter experience of 10 years' treatment. J Acute Dis 2014:201-206. doi: 10.1016/S2221-6189(14)60044-5
Falzarano G, Rollo G, Bisaccia M. et al. Percutaneous screws CT guided to fix sacroiliac joint in tile C pelvic injury. Outcomes at 5 years of follow-up. SICOT J. 2018;4:52. doi: 10.1051/sicotj/2018047.
Rovere G, Smakaj A, Perna A. et al. Correlation between traumatic pelvic ring injuries and sexual dysfunctions: a multicentric retrospective study. Int Orthop. 2023 Jun;47(6):1407-1414. doi: 10.1007/s00264-023-05767-0
Morris BJ, Richards JE, Guillamondegui OD et al. Obesity increase early complications after high-energy pelvic and acetabular fractures. Orthopedics. 2015 Oct;38(10):e881-7. doi: 10.3928/01477447-20151002-54
Karunajar MA, Shan SN, Jerebek S. Body mass index as a predictor of complications after operative treatment of acetabular fractures. J Bone Joint SurgAm 2005; 87(7): 1498-1502
Furey AJ, O'Toole RV, Nascone JW. et al. Classification of pelvic fractures: analysis of inter- and intraobserver variability using the Young-Burgess and Tile classification systems.Orthopedics. 2009;32(6):401. doi: 10.3928/01477447-20090511-05.
De Lorenzo A, Soldati L, Sarlo F, Calvani M, Di Lorenzo N, Di Renzo L. New obesity classification criteria as a tool for bariatric surgery indication. World J Gastroenterol. 2016;22(2):681-703. doi: 10.3748/wjg.v22.i2.681.
Gokalp MA, Hekimoglu Y, Gozen A, Guner S, Asirdizer M. Evaluation of Severity Score in Patients with Lower Limb and Pelvic Fractures Injured in Motor Vehicle Front-Impact Collisions. Med Sci Monit. 2016;22:4692-4698.
Adelved A, Tötterman A, Glott T, Madsen JE, Røise O. Functional outcome 10 years after surgical treatment of displaced sacral fractures. Spine (Phila Pa 1976). 2012;37(16):E1009-16. doi: 10.1097/BRS.0b013e31823a0d83.
Saracco M, Fidanza A, Necozione S, Maccauro G, Logroscino G. Could Short Stems THA Be a Good Bone-Saving Option Even in Obese Patients?. J Clin Med. 2022;11(23):7114. Published 2022 Nov 30. doi:10.3390/jcm11237114.
Denis S, Shannon HS, Wessel J, Stratford P, Weller I. Association of low back pain, impairment, disability & work limitations in nurses. J Occup Rehabil 2007; 17(2): 213-226.
Chan J, Sari I, Salonen D, Inman RD, Haroon N. Development of a Screening Tool for the Identification of Sacroiliitis in Computed Tomography Scans of the Abdomen. J Rheumatol. 2016 ;43(9):1687-94. doi: 10.3899/jrheum.150939.
Fidanza A, Rossi C, Iarussi S, Necozione S, Indelli PF, Calvisi V. Proximal humeral fractures treated with a low-profile plate with enhanced fixation properties. J Orthop Sci. 2022;27(6):1298-1303.
Keel MJ, Benneker LM, Siebenrock KA, Bastian JD. Less invasive lumbopelvic stabilization of posterior pelvic ring instability: technique and preliminary results. J Trauma. 2011;71(3):E6270. doi: 10.1097/TA.0b013e3182092e66.
Fowler TT, Bishop JA, Bellino MJ. The posterior approach to pelvic ring injuries: A technique for minimizing soft tissue complications. Injury. 2013;44(12):1780-6. doi: 10.1016/j.injury.2013.08.005.
Rocca G, Spina M, Mazzi M. Anterior Combined Endopelvic (ACE) approach for the treatment of acetabular and pelvic ring fractures: A new proposal. Injury. 2014;45 Suppl 6:S9S15. doi: 10.1016/j.injury.2014.10.016.
Fehlings MG, Wilson JR, Harrop JS et al. Efficacy and Safety of Methylprednisolone Sodium Succinate in Acute Spinal Cord Injury: A Systematic Review. Global Spine J. 2017;7(3 Suppl):116S-137S. doi: 10.1177/2192568217706366.
Medici A, Di Salvatore MG, Pezzella R, Fidanza A, De Simone AM, Calvisi V. Bilateral fractures of acetabulum in a young girl with osteogenesis imperfecta and epilepsy. Trauma Case Rep. 2019;25:100265
Randelli F, Romanini E, Biggi F. et al. II Italian intersociety consensus statement on antithrombotic prophylaxis in orthopaedics and traumatology: arthroscopy, traumatology, leg immobilization, minor orthopaedic procedures and spine surgery. J Orthop Traumatol. 2013;14(1):1-13. doi: 10.1007/s10195-012-0214-y
De Marchi B, Casati S, Tarlao G. Stakeholder appraisal of policy options for responding to obesity in Italy. Obes Rev. 2007;8 Suppl 2:83-9.
Arabi S, Wahl WL, Hemmila MR, Kohoyda-Inglis C, Taheri PA, Wang SC. The cushion effect. J Trauma 2003; 54(6): 1090-3
Kent RW, Forman JL, Bostrom O. Is There Really a “Cushion Effect”?: A Biomechanical Investigation of Crash Injury Mechanisms in the Obese. Obesity (Silver Spring). 2010;18(4):749-53.
Porter SE, Graves ML, Zhen Russel GV. Operative experience of pelvic fractures in the obese. ObesSurg 2008; 18:702-708
Carson JT, Shah SG, Ortega G, Thamyongkit S, Hasenboehler EA, Shafiq B. Complications of pelvic and acetabular fractures in 1331 morbidly obese patients (BMI ≥ 40): a retrospective observational study from the National Trauma Data Bank. Patient Saf Surg. 2018 Aug 29;12:26. doi: 10.1186/s13037-018-0172-2.
Migliore E, Pagano E, Mirabelli D. et al. Hospitalization rates and cost in severe or complicated obesity: an Italian cohort study. BMC Public Health. 2013;13:544. doi: 10.1186/1471-2458-13-544.
Nicodemo A, Cuocolo C, Capella M, Deregibus M, Massè A. Minimally invasive reduction of vertically displaced sacral fractures without use of traction table. J Orthopaed Traumatol 2011; 12:49-55
Purcell KF, Bergin PF, Spitler CA, Graves ML, Russell GV. Management of Pelvic and Acetabular Fractures in the Obese Patient. Orthop Clin North Am. 2018;49(3):317-324. doi: 10.1016/j.ocl.2018.02.005.
Salazar D, Lannon S, Pasternak O, Schiff A, Lomansney L, Mitchell E, Stover M. Investigation of bone quality of the first and second sacrale segments amongst trauma patients: Concerns about iliosacral screw fixation. J Orthop Traumatol. 2015; 16(4): 301-8.
Griffin DR, Starr AJ, Reinert CM. Vertically unstable pelvic fractures fixed with percutaneous ileo-sacral screw: does posterior injury pattern predict fixation failure? J Orthop Trauma. 2003;17:399-405
Dienstknecht T, Berner A, Lenich A, Nerlich M, Fuechtmeier B. A minimally invasive stabilizing system for dorsal pelvic ring injuries. Clin Orthop Relat Res. 2011 Nov;469(11):3209-17.
Salášek M, Jansová M, Křen J, Pavelka T, Weisová D. Biomechanical comparison of a transiliac internal fixator and two iliosacral screws in transforaminal sacral fractures: a finite element analysis. Acta Bioeng Biomech. 2015;17(1):39-49.
Sagi HD. Technical aspects and recommended treatment algorithms in triangular osteosynthesis and spinopelvic fixation for vertical shear transformational sacral fractures. J Ortop Trauma 2009; 23:354-360
Hu X, Pei F, Wang G, He J, Kong Q, Tu C. Application triangular osteosynthesis for vertical unstable sacral fractures. Eur Spine J. 2013;22(3):503-9.
Schildhauer TA, Ledoux WR, Chapman JR, Henley MB, Tencer AF, Routt ML jr. Triangular Osteosynthesis and ileo-sacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma 2003; 17:22-31
Salari P, Moed BR, Bledsoe JG. Supplemental S1 fixation for type C pelvic ring injuries: biomechanical study of a long iliosacral versus transsacral screw. J OrthopTraumatol. 2015 Dec;13(4):293-300
Reynolds M, Driver S, Bennett M, Patel S, Rainey E, Warren AM. Examining the relationship between obesity and mental health outcomes among individuals admitted to a level I trauma centre. Clin Obes. 2018 Oct;8(5):337-344. doi: 10.1111/cob.12264.
Papasotiriou AN, Prevezas N, Krikonis K, Alexopoulos EC. Recovery and Return to Work After a Pelvic Fracture. Saf Health Work. 2017 Jun;8(2):162-168. doi: 10.1016/j.shaw.2016.10.003.
Ciolli G, Caviglia D, Vitiello C. et al. Navigated percutaneous screw fixation of the pelvis with O-arm 2: two years' experience. Med Glas (Zenica). 2021 Feb 1;18(1):309-315. doi: 10.17392/1326-21. PMID: 33480224.
Rovere G, Perna A, Meccariello L. et al. Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review. Int Orthop. 2021 Oct;45(10):2687-2697. doi: 10.1007/s00264-021-05153-8. Epub 2021 Aug 10. PMID: 34378143; PMCID: PMC8514382.
Florio M, Capasso L, Olivi A, Vitiello C, Leone A, Liuzza F. 3D - Navigated percutaneous screw fixation of pelvic ring injuries - a pilot study. Injury. 2020 Aug;51 Suppl 3:S28-S33. doi: 10.1016/j.injury.2020.07.025. Epub 2020 Jul 10. Erratum in: Injury. 2021 Apr;52(4):1103. PMID: 32723529.
Napoli N, Rini GB, Serber D. ET AL. The Val432Leu polymorphism of the CYP1B1 gene is associated with differences in estrogen metabolism and bone density. Bone. 2009 Mar;44(3):442-8. doi: 10.1016/j.bone.2008.09.018. Epub 2008 Oct 15. PMID: 18977467; PMCID: PMC3966713.
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Copyright (c) 2023 Francesco Liuzza, MD, Amarildo Smakaj, MD, Giuseppe Rovere, MD, PhD, Domenico De Mauro, MD, Giuseppe Rollo, MD, Rocco Erasmo, MD, Andrea Fidanza, MD, PhD, FIOTA, Predrag Gruobor, MD, Luigi Meccariello, MD
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