Treatment of unstable pelvic and acetabular fractures in a hospital of Bogotá D.C., Colombia: a case series

Authors

  • Javier Matta-Ibarra Hospital Militar Central, Orthopedics and Trauma Department, Bogotá, D.C., Colombia. | Universidad Militar Nueva Granada, Spine, Pelvis, and Acetabulum Surgery Specialty Program, Bogotá, D.C., Colombia. https://orcid.org/0009-0008-4454-1411
  • Víctor Arrieta-María Hospital Militar Central, Orthopedics and Trauma Department, Bogotá, D.C., Colombia. | Universidad Militar Nueva Granada, Spine, Pelvis, and Acetabulum Surgery Specialty Program, Bogotá, D.C., Colombia. https://orcid.org/0009-0002-9521-162X
  • Carlos Rosales-Posada Hospital Militar Central, Orthopedics and Trauma Department, Bogotá, D.C., Colombia. https://orcid.org/0000-0002-7564-149X
  • Esteban Araya-Ramírez Hospital Militar Central, Orthopedics and Trauma Department, Bogotá, D.C., Colombia. https://orcid.org/0000-0002-6087-3394
  • Juan Guevara-Serna Hospital Militar Central, Orthopedics and Trauma Department, Bogotá, D.C., Colombia. | Universidad Militar Nueva Granada, Spine, Pelvis, and Acetabulum Surgery Specialty Program, Bogotá, D.C., Colombia. https://orcid.org/0000-0003-1357-3281
  • Julio Pérez-Oliva Universidad Militar Nueva Granada, Spine, Pelvis, and Acetabulum Surgery Specialty Program, Bogotá, D.C., Colombia. https://orcid.org/0000-0001-6328-7991
  • Juan Carlos Andrade-Rodríguez Hospital Militar Central, Orthopedics and Trauma Department, Bogotá, D.C., Colombia. | Universidad Militar Nueva Granada, Spine, Pelvis, and Acetabulum Surgery Specialty Program, Bogotá, D.C., Colombia. https://orcid.org/0000-0002-5872-7304
  • Gustavo Rozo-López Hospital Militar Central, Orthopedics and Trauma Department, Bogotá, D.C., Colombia. | Universidad Militar Nueva Granada, Spine, Pelvis, and Acetabulum Surgery Specialty Program, Bogotá, D.C., Colombia. https://orcid.org/0000-0003-0151-7805

DOI:

https://doi.org/10.58814/01208845.27

Keywords:

Acetabulum, Pelvic Bones, Bone Fractures, Trauma Severity Indices

Abstract

Introduction: Unstable fractures of the pelvis and acetabulum (UFPA) are rare injuries caused by high-energy trauma. Their treatment is challenging due to their high morbidity and mortality.

Objectives: To describe the characteristics of patients presenting with UFPA treated at the Hospital Militar Central de Bogotá D.C., Colombia, and to present flow charts for the treatment of these injuries based on the institutional experience.

Methodology: Retrospective case series that included 203 patients operated on due to UFPA who were treated at the Hospital Militar Central (HMC), a quaternary care institution, between January 1992 and January 2021. The patients' sociodemographic and clinical data were obtained by reviewing their medical records.

Results: The mean age of the patients was 34 years, 81.77% (n=166) were male, and the mechanism of injury was motor vehicle accident in 90.14% (n=183). It was found that 90 (44.33%) patients had fractures of the pelvic ring only, 81 (39.90%) had fractures of the acetabulum only, 25 (12.31%) had combined fractures, and 7 (3.44%) had spinopelvic dissociation. A total of 263 surgical procedures were performed: 119 (45.25%) for the treatment of pelvic ring fractures and 144 (54.75%) for the treatment of fractures of the acetabulum. Regarding fractures of the acetabulum (n=113), 2 surgical approaches were required in the same surgical procedure in some cases. Finally, adequate functional outcomes were observed in 75% of the patients at the last follow-up, and only 11.33% presented complications.

Conclusion: Most of the patients with UFPA treated at the HMC during the study period were young men. There was a similar distribution of acetabular fractures and pelvic ring fractures, and the main cause of fractures was motor vehicle accidents. Furthermore, adequate functional outcomes were achieved in more than 70% of patients and the complication rate was low. Finally, the flow charts presented allow optimizing and standardizing the surgical treatment of these injuries.

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References

Balogh Z, King KL, Mackay P, McDougall D, Mackenzie S, Evans JA, et al. The Epidemiology of Pelvic Ring Fractures: A Population-Based Study. J Trauma. 2007;63(5):1066-73. https://doi.org/fps97z.

Pereira GJC, Damasceno ER, Dinhane DI, Bueno FM, Leite JBR, Ancheschi B da C. Epidemiology of pelvic ring fractures and injuries. Rev Bras Ortop. 2017;52(3):260-9. https://doi.org/gbmtsh.

Gänsslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H. Epidemiology of pelvic ring injuries. Injury. 1996;27:13-20.

Hauschild O, Strohm PC, Culemann U, Pohlemann T, Suedkamp NP, Koestler W, et al. Mortality in patients with pelvic fractures: results from the German pelvic injury register. J Trauma. 2008;64(2):449-55. https://doi.org/fgbtnf.

Mardanpour K, Rahbar M. The outcome of surgically treated traumatic unstable pelvic fractures by open reduction and internal fixation. J Inj Violence Res. 2013;5(2):77-83. https://doi.org/gm4zx8.

Matta J, Arrieta V, Torres F, Avendaño N, Escobar M, Andrade J. Estabilización quirúrgica espinopélvica: Serie de casos. Rev Colomb Ortop Traumatol. 2014;28(2):55-62. https://doi.org/f3jb6v.

Matta J, Rintá M, Castro J. Fijación interna de las Fracturas del acetábulo. Experiencia Hospital Militar Central-10 años. Rev Colomb Ortop Traumatol. 2005;19(2):19-26.

Matta JM. Operative indications and choice of surgical approach for fractures of the acetabulum. Tech Orthop. 1986;1(1):13-22.

Tile M, Helfet D, Kellam J, Vrahas M. Fractures of the Pelvis and Acetabulum -Principles and Methods of Management. Stuttgart: AO Foundation: 2015. https://doi.org/m9r8.

Roy-Camille R, Saillant G, Gagna G, Mazel C. Transverse fracture of the upper sacrum. Suicidal jumper’s fracture. Spine. 1985;10(9):838-45.

Kai-Xing Lee A, Lin TL, Hsu CJ, Fong YC, Chen HT, Tsai CH. Three-Dimensional Printing and Fracture Mapping in Pelvic and Acetabular Fractures: A Systematic Review and Meta-Analysis. J Clin Med. 2022;11(18):5258. https://doi.org/m9mh.

Bellabarba C, Schroeder GD, Kepler CK, Kurd MF, Kleweno CP, Firoozabadi R, et al. The AOSpine Sacral Fracture Classification. Global Spine J. 2017;6(Suppl 1). https://doi.org/m9ng.

Alton TB, Gee AO. Classifications in brief: Letournel classification for acetabular fractures. Clin Orthop Relat Res. 2014;472(1):35-8. https://doi.org/m9nh.

Rüedi TP, Murphy WM. AO Principles of Fracture Management. New York: AO Publishing; 2000.

Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018;32(Suppl 1):S1-S170. https://doi.org/m9nh.

Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury. 2004;35(7):671-7. https://doi.org/dpzgkv.

Marzi I, Lustenberger T. Management of Bleeding Pelvic Fractures. Scand J Surg. 2014;103(2):104-11. https://doi.org/f5627n.

Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187-96.

Flint L, Cryer HG. Pelvic fracture: the last 50 years. J Trauma. 2010;69(3):483-8. https://doi.org/bpfwj2.

Lee AKX, Lin TL, Hsu CJ, Fong YC, Chen HT, Tsai CH. Three-Dimensional Printing and Fracture Mapping in Pelvic and Acetabular Fractures: A Systematic Review and Meta-Analysis. J Clin Med. 2022;11(18):5258. https://doi.org/m9mh.

Papakostidis C, Kanakaris NK, Kontakis G, Giannoudis PV. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop. 2009;33(2):329-38. https://doi.org/ctnzhp.

Gruen GS, Leit ME, Gruen RJ, Garrison HG, Auble TE, Peitzman AB. Functional outcome of patients with unstable pelvic ring fractures stabilized with open reduction and internal fixation. J Trauma. 1995;39(5):838-44. https://doi.org/bs5p3m.

Freire W, Gómez L. Manejo de las fracturas de acetábulo. Experiencia 5 años. Rev. Colomb. Ortop Traumatol. 2009;23(2):103-8.

Cole JD, Blum DA, Ansel LJ. Outcome after fixation of unstable posterior pelvic ring injuries. Clin Orthop Relat Res. 1996;(329):160-79. https://doi.org/cxsfhz.

Matta JM, Tornetta P, 3rd. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res. 1996;(329):129-40. https://doi.org/fpw46s.

Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clin Orthop Relat Res. 1989;(242):83-97.

World Medical Association (WMA). WMA Declaration of Helsinki – Ethical principles for medical research involving human subjects. Fortaleza: 64th WMA General Assembly; 2013.

Colombia. Ministerio de Salud. Resolución 8430 de 1993 (octubre 4): Por la cual se establecen las normas científicas, técnicas y administrativas para la investigación en salud. Bogotá D.C.; octubre 4 de 1993 [cited 2024 Jul 22]. Disponible en: https://bit.ly/31gu7do.

Millis MB, Hall JE. Transiliac lengthening of the lower extremity. A modified innominate osteotomy for the treatment of postural imbalance. J Bone Joint Surg Am. 1979;61(8):1182-94.

Mears DC, Rubash HE. Extensile exposure of the pelvis. Contemp Orthop. 1983;6:21-31.

Matta J, Rodríguez J, Alvarado C, Ochoa G, Matamoros C, Rojas G. Diseño y evaluación clínica de las técnicas de fijación interna modificadas del esqueleto axil instrumentación analítica. Rev. Colomb. Ortop. Traumatol. 1995;9(1):37-48.

Archdeacon MT, Kazemi N, Guy P, Sagi HC. The Modified Stoppa Approach for Acetabular Fracture. J Am Acad Orthop Surg. 2011;19(3):170-5. https://doi.org/m9nn.

Suzuki T, Smith WR, Hak DJ, Stahel PF, Baron AJ, Gillani SA, et al. Combined injuries of the pelvis and acetabulum: nature of a devastating dyad. J Orthop Trauma. 2010;24(5):303-8. https://doi.org/m9nn.

Dong JL, Zhou DS. Management and outcome of open pelvic fractures: a retrospective study of 41 cases. Injury. 2011;42(10):1003-7. https://doi.org/bxf9p7.

Hermans E, Edwards MJR, Goslings JC, Biert J. Open pelvic fracture: the killing fracture? J Orthop Surg Res. 2018;13(1):83. https://doi.org/m9np.

Gansslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H. Epidemiology of pelvic ring injuries. Injury. 1996;27(Suppl 1):S-a13-20.

Vallier HA, Cureton BA, Ekstein C, Oldenburg FP, Wilber JH. Early definitive stabilization of unstable pelvis and acetabulum fractures reduces morbidity. J Trauma. 2010;69(3):677-84. https://doi.org/dnfpjw.

Matta J, Arrieta V, Marín M, Guevara J, Ramírez A. Cirugía reconstructiva en estadios para el manejo del traumatismo pélvico inveterado. Serie de casos. Rev. Colomb. Ortop. Traumatol. 2016;30(1):23-30. https://doi.org/m9nq.

Gardner MJ, Routt ML, Jr. Transiliac-transsacral screws for posterior pelvic stabilization. J Orthop Trauma. 2011;25(6):378-84. https://doi.org/fvqz2p.

Matta J, Ferguson A, Salmanca J. Diseño y modificación de técnicas de fijación interna del esqueleto axil. Instrumentación analítica. Investigación básica. Rev. Colomb. Ortop. Traumatol. 1995;9(1):27-35.

Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology. 1986;160(2):445-51. https://doi.org/gnnqm3.

Tis JE, Helgeson MD, Lehman RA, Dmitriev AE. A Biomechanical Comparison of Different Types of Lumbopelvic Fixation. Spine. 2009;34(24):E866-72. https://doi.org/ccbwff.

Shan Chou DT, El-Daly I, Ranganathan, Montgomery A, Culpan P, Bates P. Spinopelvic Dissociation: A Retrospective Case Study and Review of Treatment Controversies. J Am Acad Orthop Surg. 2018;26(14):e302-e312. https://doi.org/m9md.

Li R, Zhao P, Guan J, Wang X, Liu L, Wu M. Combined pelvic and acetabular injuries: clinical features and treatment strategies of a unique injury pattern. J Orthop Surg Res. 2023;18(1):415. https://doi.org/m9mf.

Enocson A, Lundin N. Early versus late surgical treatment of pelvic and acetabular fractures: a five-year follow-up of 419 patients. BMC Musculoskelet Disord. 2023;24(1):848. https://doi.org/gs8hwt.

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Published

2024-07-31

How to Cite

1.
Matta-Ibarra J, Arrieta-María V, Rosales-Posada C, Araya-Ramírez E, Guevara-Serna J, Pérez-Oliva J, et al. Treatment of unstable pelvic and acetabular fractures in a hospital of Bogotá D.C., Colombia: a case series. Rev. Colomb. Ortop. Traumatol. [Internet]. 2024 Jul. 31 [cited 2025 May 10];38(3):e27. Available from: https://revistasccotorg.biteca.online/index.php/rccot/article/view/27

Issue

Vol. 38 No. 3 (2024)

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Original research

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