Objectives: Early pelvic binder placement in the field stabilizes pelvic fractures and tamponades potential hemorrhage within the pelvis. Despite known risk factors for pelvic fracture, it remains challenging to quickly triage and correctly apply a pelvic binder. We aim to develop a prediction model that exclusively uses prehospital criteria to inform the decision to place a pelvic binder.
Methods: The trauma registry was used to identify all trauma patients admitted to an urban Level I trauma center between January 2013 and December 2017. Variables collected included patient demographics, mechanism of injury, prehospital vital signs, and the presence of a pelvic fracture. Participants were randomly assigned to a training group (70%) or a validation group (30%). Univariate analyses were used to identify significant predictors for use in multivariate predictive models.
Results: A total of 8,480 (65% male; median age 49; median ISS 9) and 3,676 (65% male; median age 48; median ISS 9) trauma patients were randomly assigned to the training and validation groups, respectively. Univariate analysis showed significant likelihood of pelvic fracture associated with female sex, hemodynamic instability (initial systolic blood pressure < 90 mmHg), blunt injury type, specific mechanisms of injury (motor vehicle collision, motorcycle collision, pedestrian struck by motor vehicle, crushing injury, and riding an animal), impact location, and position in vehicle. Multivariate models adjusting for blunt type injury, hemodynamic instability, impact location, and position in vehicle showed that presence of two or more of these risk factors is significantly associated with presence of pelvic fracture.
Conclusion: Establishing select prehospital criteria for the empiric application of pelvic binders for patients in the field with blunt injuries, hemodynamic instability, frontal or side motor vehicle collision impact, and non-front seat passenger may improve outcomes among patients with pelvic fractures.
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http://dx.doi.org/10.1080/10903127.2023.2213316 | DOI Listing |
Oper Orthop Traumatol
December 2024
Department of Orthopedics and Traumatology, Centre Hospitalier Universitaire Vaudois, (CHUV), Rue de Bugnon 46, 1011, Lausanne, Switzerland.
Objective: Minimally invasive percutaneous techniques are used to stabilize fractures of the anterior pelvic ring. Stabilization of the fracture facilitates early mobilization and rehabilitation, while percutaneous techniques reduce complications such as infection and bleeding.
Indications: Indicated for patients with non- or minimally displaced fractures of the anterior pelvic ring, or if fracture displacement can be reduced using minimally invasive techniques.
Cureus
November 2024
Orthopaedics, Glasgow Royal Infirmary, Glasgow, GBR.
Osteoporosis is a major risk factor for fragility fractures. The British Orthopaedics Association Standards for Trauma and Orthopaedics (BOAST) and Getting it Right First Time (GIRFT) guidelines on fragility fracture management highlight the need to initiate prompt, coordinated multidisciplinary care with a focus on early mobilisation to improve patient outcomes. Medical management of fragility fractures focuses on the prevention of progressive frailty.
View Article and Find Full Text PDFRev Bras Ortop (Sao Paulo)
December 2024
Departamento de Ortopedia e Traumatologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
This study evaluated lumbar spine radiographs using the Choi and Patgaonkar classifications to verify parameters potentially influencing the L5-S1 transforaminal approach. We studied 167 lumbosacral spine radiographs from patients over 18 years old with no history of surgeries, tumors, fractures, or scoliosis to measure the iliac crest height and rim angle. We categorized the cases per pelvic morphology, mega-apophysis presence, and Choi and Patgaonkar classifications.
View Article and Find Full Text PDFJ Clin Densitom
November 2024
Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, 2713, Qatar. Electronic address:
Background: Bone mineral density (BMD) is an indicator of bone health that predicts future bone fractures. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is used to assess the severity of symptoms related to pain, stiffness, and function in diseased hip and knee joints. Here we assessed whether BMD measured at specific sites predicts WOMAC scores in healthy individuals whilst controlling for sociodemographic variables.
View Article and Find Full Text PDFArch Orthop Trauma Surg
December 2024
Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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