Clinical and radiological aspects of traumatic pelvic ring injury

Epidemiological data regarding High-Energy Traumatic Pelvic Ring Injury in Sweden was missing. Further, there was no data regarding current knowledge and level of experience of Swedish first line trauma officers about the management of traumatic pelvic ring injury. While conventional X-ray has been widely criticized as an optimal tool in assessment of pelvic ring injuries, a practical substitute has not been proposed.

We planned to study epidemiological aspects of High Energy Traumatic Pelvic Ring Injury using data from the Karolinska Trauma Center. To assess first line trauma medical officer’s knowledge and level of experience regarding acute management of pelvic trauma. To investigate alternative practical options instead of conventional X-ray during the treatment of pelvic fractures. We used data from the Swedish National Trauma Registry (SweTrau). We used the Karolinska University Hospital´s Patient Notes and PACS. We used a questionnaire in order to assess Swedish trauma unit’s medical officers about acute management of pelvic trauma. We further used three dimensional models for image fusion and motion analysis in order to investigate symmetry of human pelvis and to investigate a pelvic fracture model. We found that the incidence of High Energy Traumatic Pelvic Ring Injury was about 3.5/100 000 inhabitants per year in Stockholm. The 30-day mortality was 7.8% and the 1 year mortality was 9%. The main cause of mortality was traumatic brain injury. Intentional injuries had a mortality rate of 15%. The reoperation frequency was 22%. Main cause of reoperation was due to metalwork problems, and a majority of them were potentially avoidable.

We found that a majority of the Swedish first line trauma officers were aware of presence of a pelvic binder in their department and knew how to apply it, while there was more experience in the university hospitals. There was a general misconception regarding limitation of pelvic binders as 55% believed that a pelvic binder can stop an arterial bleeding. We were further able to show that human hemi pelvises are symmetrical and the 3D images of the contralateral hemi pelvis can be used for pre-operative templating. We were able to show that using fusion of serial 3D images of a pelvic model, translations of ±0.2 mm and rotations of ±0.2° could be detected.

We can hereby conclude that monitoring 30-day mortality seems enough while studying high energy pelvic injuries. Intentional injuries need further future studies as per high mortality rate. Reoperation frequency following fixation of disrupted high energy pelvic fractures is high and needs addressing and early detection. Limitations of pelvic binders should be addressed during the trauma courses. Low dose CT-scan together with serial image fusion can be a future substitute for conventional X-ray. Human hemi pelvises are symmetrical and the contralateral side can be used for templating.

List of scientific papers

I. Bakhshayesh P, Weidenhielm L, Enocson A. Factors affecting mortality and reoperations in high-energy pelvic fractures. European journal of Orthopaedic Surgery & Traumatology. 2018;28:1273-82.
https://doi.org/10.1007/s00590-018-2203-1

II. Bakhshayesh P, Heljesten S, Weidenhielm L, Enocson A. Experience and Availability of Pelvic Binders at Swedish Trauma Units; A Nationwide Survey. Bull Emerg Trauma. 2018;6:221-5.
https://doi.org/10.29252/beat-060306

III. Bakhshayesh P, Olivecrona H, Weidenhielm L, Enocson A. A New CT Based Method for Post-operative Motion Analysis of Pelvic Fractures. 3D Research. 2019;10:7.
https://doi.org/10.1007/s13319-019-0217-z

IV. A Novel 3D Technique to Assess Symmetry of Hemi Pelvises. Bakhshayesh P, Zaghlul A, Sephton B, Enocson A. [Manuscript]