Detection of posterior pelvic injuries in fractures of the pubic rami

Abstract Background Fractures of the pubic rami are associated with prolonged pain, bed rest and increased morbidity and mortality. Often no further diagnostic work-up is undertaken and the pubic rami fractures are classified as stable injuries. However, fractured pubic rami seem to be only part of...

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Veröffentlicht in:Injury 2012-08, Vol.43 (8), p.1326-1329
Hauptverfasser: Scheyerer, Max J, Osterhoff, Georg, Wehrle, Silvio, Wanner, Guido A, Simmen, Hans-Peter, Werner, Clement M.L
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container_end_page 1329
container_issue 8
container_start_page 1326
container_title Injury
container_volume 43
creator Scheyerer, Max J
Osterhoff, Georg
Wehrle, Silvio
Wanner, Guido A
Simmen, Hans-Peter
Werner, Clement M.L
description Abstract Background Fractures of the pubic rami are associated with prolonged pain, bed rest and increased morbidity and mortality. Often no further diagnostic work-up is undertaken and the pubic rami fractures are classified as stable injuries. However, fractured pubic rami seem to be only part of the picture and are often associated with posterior pelvic ring injury. This retrospective study was designed to evaluate the posterior ring for undetected injury in patients diagnosed with pubic rami fractures. Methods All patients ( n = 233) with diagnosed fractures of the pubic rami were retrospectively retrieved. All patients with a CT scan available at time of admission ( n = 177) were included in the study. Results In 28.8% of the cases a fracture of the acetabulum was found additionally to the pubic rami. In cases without obvious other injury of the ap radiograph, an injury of the posterior pelvic ring was found on CT scans in 96.8% of the patients. Most lesions represented transforaminal sacral fractures, avulsion fractures of ligaments or compression fractures of the lateral mass. All patients with dorsal injuries could initially be treated conservatively, nevertheless 30% of them needed operative treatment in the course. Conclusion Nearly all cases with fractures of the pubic rami do have a lesion elsewhere within the pelvic ring. In patients with prolonged pain and immobility following ‘pubic rami fractures’ one should be aware that they probably represent an undiagnosed pelvic ring injury and further diagnostic work-up – sometimes even surgery – is warranted.
doi_str_mv 10.1016/j.injury.2012.05.016
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Often no further diagnostic work-up is undertaken and the pubic rami fractures are classified as stable injuries. However, fractured pubic rami seem to be only part of the picture and are often associated with posterior pelvic ring injury. This retrospective study was designed to evaluate the posterior ring for undetected injury in patients diagnosed with pubic rami fractures. Methods All patients ( n = 233) with diagnosed fractures of the pubic rami were retrospectively retrieved. All patients with a CT scan available at time of admission ( n = 177) were included in the study. Results In 28.8% of the cases a fracture of the acetabulum was found additionally to the pubic rami. In cases without obvious other injury of the ap radiograph, an injury of the posterior pelvic ring was found on CT scans in 96.8% of the patients. Most lesions represented transforaminal sacral fractures, avulsion fractures of ligaments or compression fractures of the lateral mass. All patients with dorsal injuries could initially be treated conservatively, nevertheless 30% of them needed operative treatment in the course. Conclusion Nearly all cases with fractures of the pubic rami do have a lesion elsewhere within the pelvic ring. In patients with prolonged pain and immobility following ‘pubic rami fractures’ one should be aware that they probably represent an undiagnosed pelvic ring injury and further diagnostic work-up – sometimes even surgery – is warranted.</description><identifier>ISSN: 0020-1383</identifier><identifier>EISSN: 1879-0267</identifier><identifier>DOI: 10.1016/j.injury.2012.05.016</identifier><identifier>PMID: 22682148</identifier><language>eng</language><publisher>Netherlands: Elsevier Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Fractures, Bone - complications ; Fractures, Bone - diagnostic imaging ; Fractures, Bone - physiopathology ; Fractures, Bone - surgery ; Humans ; Male ; Middle Aged ; Orthopedics ; Osteoporotic Fractures - diagnostic imaging ; Osteoporotic Fractures - physiopathology ; Osteoporotic Fractures - surgery ; Pelvic Bones - diagnostic imaging ; Pelvic Bones - injuries ; Pelvic Bones - physiopathology ; Pelvic Bones - surgery ; Pelvic fractures ; Pelvic Pain - etiology ; Posterior pelvic ring injuries ; Pubic Bone - diagnostic imaging ; Pubic Bone - injuries ; Pubic Bone - surgery ; Pubic rami ; Retrospective Studies ; Tomography, X-Ray Computed ; Weight-Bearing ; Young Adult</subject><ispartof>Injury, 2012-08, Vol.43 (8), p.1326-1329</ispartof><rights>Elsevier Ltd</rights><rights>2012 Elsevier Ltd</rights><rights>Copyright © 2012 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-f77f3988b64756d870c33452661027f1f817ec417f966a9b459d424d2d34e47c3</citedby><cites>FETCH-LOGICAL-c417t-f77f3988b64756d870c33452661027f1f817ec417f966a9b459d424d2d34e47c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.injury.2012.05.016$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22682148$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Scheyerer, Max J</creatorcontrib><creatorcontrib>Osterhoff, Georg</creatorcontrib><creatorcontrib>Wehrle, Silvio</creatorcontrib><creatorcontrib>Wanner, Guido A</creatorcontrib><creatorcontrib>Simmen, Hans-Peter</creatorcontrib><creatorcontrib>Werner, Clement M.L</creatorcontrib><title>Detection of posterior pelvic injuries in fractures of the pubic rami</title><title>Injury</title><addtitle>Injury</addtitle><description>Abstract Background Fractures of the pubic rami are associated with prolonged pain, bed rest and increased morbidity and mortality. Often no further diagnostic work-up is undertaken and the pubic rami fractures are classified as stable injuries. However, fractured pubic rami seem to be only part of the picture and are often associated with posterior pelvic ring injury. This retrospective study was designed to evaluate the posterior ring for undetected injury in patients diagnosed with pubic rami fractures. Methods All patients ( n = 233) with diagnosed fractures of the pubic rami were retrospectively retrieved. All patients with a CT scan available at time of admission ( n = 177) were included in the study. Results In 28.8% of the cases a fracture of the acetabulum was found additionally to the pubic rami. In cases without obvious other injury of the ap radiograph, an injury of the posterior pelvic ring was found on CT scans in 96.8% of the patients. Most lesions represented transforaminal sacral fractures, avulsion fractures of ligaments or compression fractures of the lateral mass. All patients with dorsal injuries could initially be treated conservatively, nevertheless 30% of them needed operative treatment in the course. Conclusion Nearly all cases with fractures of the pubic rami do have a lesion elsewhere within the pelvic ring. In patients with prolonged pain and immobility following ‘pubic rami fractures’ one should be aware that they probably represent an undiagnosed pelvic ring injury and further diagnostic work-up – sometimes even surgery – is warranted.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Female</subject><subject>Fractures, Bone - complications</subject><subject>Fractures, Bone - diagnostic imaging</subject><subject>Fractures, Bone - physiopathology</subject><subject>Fractures, Bone - surgery</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Osteoporotic Fractures - diagnostic imaging</subject><subject>Osteoporotic Fractures - physiopathology</subject><subject>Osteoporotic Fractures - surgery</subject><subject>Pelvic Bones - diagnostic imaging</subject><subject>Pelvic Bones - injuries</subject><subject>Pelvic Bones - physiopathology</subject><subject>Pelvic Bones - surgery</subject><subject>Pelvic fractures</subject><subject>Pelvic Pain - etiology</subject><subject>Posterior pelvic ring injuries</subject><subject>Pubic Bone - diagnostic imaging</subject><subject>Pubic Bone - injuries</subject><subject>Pubic Bone - surgery</subject><subject>Pubic rami</subject><subject>Retrospective Studies</subject><subject>Tomography, X-Ray Computed</subject><subject>Weight-Bearing</subject><subject>Young Adult</subject><issn>0020-1383</issn><issn>1879-0267</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUtLxTAQhYMoen38A5Eu3bTm1aTdCKLXBwgu1HVo0wmm9jY1aYX77029VxduXGUyfGcOcwahU4Izgom4aDPbt5NfZxQTmuE8i80dtCCFLFNMhdxFC4wpTgkr2AE6DKHFmEjM2D46oFQUlPBigZY3MIIeresTZ5LBhRG8dT4ZoPu0Ovm2sBBikRhf6XHy8RPJ8Q2SYaoj4quVPUZ7puoCnGzfI_R6u3y5vk8fn-4erq8eU82JHFMjpWFlUdSCy1w0hcSaMZ5TIQim0hBTEAkzakohqrLmedlwyhvaMA5canaEzjdzB-8-JgijWtmgoeuqHtwUVBzDWU65kBHlG1R7F4IHowZvV5VfR0jNAapWbQJUc4AK5yo2o-xs6zDVK2h-RT-JReByA0Dc89OCV0Fb6DU01scgVePsfw5_B-jO9lZX3TusIbRu8n3MUBEVokY9z0ecb0joXFHCvgC1ipbb</recordid><startdate>20120801</startdate><enddate>20120801</enddate><creator>Scheyerer, Max J</creator><creator>Osterhoff, Georg</creator><creator>Wehrle, Silvio</creator><creator>Wanner, Guido A</creator><creator>Simmen, Hans-Peter</creator><creator>Werner, Clement M.L</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120801</creationdate><title>Detection of posterior pelvic injuries in fractures of the pubic rami</title><author>Scheyerer, Max J ; Osterhoff, Georg ; Wehrle, Silvio ; Wanner, Guido A ; Simmen, Hans-Peter ; Werner, Clement M.L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-f77f3988b64756d870c33452661027f1f817ec417f966a9b459d424d2d34e47c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Female</topic><topic>Fractures, Bone - complications</topic><topic>Fractures, Bone - diagnostic imaging</topic><topic>Fractures, Bone - physiopathology</topic><topic>Fractures, Bone - surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Osteoporotic Fractures - diagnostic imaging</topic><topic>Osteoporotic Fractures - physiopathology</topic><topic>Osteoporotic Fractures - surgery</topic><topic>Pelvic Bones - diagnostic imaging</topic><topic>Pelvic Bones - injuries</topic><topic>Pelvic Bones - physiopathology</topic><topic>Pelvic Bones - surgery</topic><topic>Pelvic fractures</topic><topic>Pelvic Pain - etiology</topic><topic>Posterior pelvic ring injuries</topic><topic>Pubic Bone - diagnostic imaging</topic><topic>Pubic Bone - injuries</topic><topic>Pubic Bone - surgery</topic><topic>Pubic rami</topic><topic>Retrospective Studies</topic><topic>Tomography, X-Ray Computed</topic><topic>Weight-Bearing</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scheyerer, Max J</creatorcontrib><creatorcontrib>Osterhoff, Georg</creatorcontrib><creatorcontrib>Wehrle, Silvio</creatorcontrib><creatorcontrib>Wanner, Guido A</creatorcontrib><creatorcontrib>Simmen, Hans-Peter</creatorcontrib><creatorcontrib>Werner, Clement M.L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Injury</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scheyerer, Max J</au><au>Osterhoff, Georg</au><au>Wehrle, Silvio</au><au>Wanner, Guido A</au><au>Simmen, Hans-Peter</au><au>Werner, Clement M.L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Detection of posterior pelvic injuries in fractures of the pubic rami</atitle><jtitle>Injury</jtitle><addtitle>Injury</addtitle><date>2012-08-01</date><risdate>2012</risdate><volume>43</volume><issue>8</issue><spage>1326</spage><epage>1329</epage><pages>1326-1329</pages><issn>0020-1383</issn><eissn>1879-0267</eissn><abstract>Abstract Background Fractures of the pubic rami are associated with prolonged pain, bed rest and increased morbidity and mortality. Often no further diagnostic work-up is undertaken and the pubic rami fractures are classified as stable injuries. However, fractured pubic rami seem to be only part of the picture and are often associated with posterior pelvic ring injury. This retrospective study was designed to evaluate the posterior ring for undetected injury in patients diagnosed with pubic rami fractures. Methods All patients ( n = 233) with diagnosed fractures of the pubic rami were retrospectively retrieved. All patients with a CT scan available at time of admission ( n = 177) were included in the study. Results In 28.8% of the cases a fracture of the acetabulum was found additionally to the pubic rami. In cases without obvious other injury of the ap radiograph, an injury of the posterior pelvic ring was found on CT scans in 96.8% of the patients. Most lesions represented transforaminal sacral fractures, avulsion fractures of ligaments or compression fractures of the lateral mass. All patients with dorsal injuries could initially be treated conservatively, nevertheless 30% of them needed operative treatment in the course. Conclusion Nearly all cases with fractures of the pubic rami do have a lesion elsewhere within the pelvic ring. In patients with prolonged pain and immobility following ‘pubic rami fractures’ one should be aware that they probably represent an undiagnosed pelvic ring injury and further diagnostic work-up – sometimes even surgery – is warranted.</abstract><cop>Netherlands</cop><pub>Elsevier Ltd</pub><pmid>22682148</pmid><doi>10.1016/j.injury.2012.05.016</doi><tpages>4</tpages></addata></record>
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subjects Adolescent
Adult
Aged
Aged, 80 and over
Female
Fractures, Bone - complications
Fractures, Bone - diagnostic imaging
Fractures, Bone - physiopathology
Fractures, Bone - surgery
Humans
Male
Middle Aged
Orthopedics
Osteoporotic Fractures - diagnostic imaging
Osteoporotic Fractures - physiopathology
Osteoporotic Fractures - surgery
Pelvic Bones - diagnostic imaging
Pelvic Bones - injuries
Pelvic Bones - physiopathology
Pelvic Bones - surgery
Pelvic fractures
Pelvic Pain - etiology
Posterior pelvic ring injuries
Pubic Bone - diagnostic imaging
Pubic Bone - injuries
Pubic Bone - surgery
Pubic rami
Retrospective Studies
Tomography, X-Ray Computed
Weight-Bearing
Young Adult
title Detection of posterior pelvic injuries in fractures of the pubic rami
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