Original Article

Validated Radiographic Scoring System for Lateral Compression Type 1 Pelvis Fractures

Beckmann, James MD^*; Haller, Justin M. MD^†; Beebe, Michael MD^‡; Ali, Ashley MD^§; Presson, Angela PhD^║; Stuart, Ami PhD^¶; Sagi, Henry Claude MD^**; Kubiak, Erik MD^††

Author Information

^*St. Luke's Health System, Boise, ID;

^†Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT;

^‡Department of Orthopaedic Surgery, Campbell Clinic, Memphis, TN;

^§Department of Orthopaedic Surgery, University of South Florida, Tampa, FL;

^║Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT;

^¶Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT;

^**Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH; and

^††University of Nevada, Reno School of Medicine, Las Vegas, NV.

Reprints: Justin M. Haller, MD, Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108 (e-mail: [email protected]).

J. M. Haller is a paid lecturer for AO North America and had paid travel and accommodation from Newclip Technics for consulting. The remaining authors report no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com).

Journal of Orthopaedic Trauma 34(2):p 70-76, February 2020. | DOI: 10.1097/BOT.0000000000001639

Abstract

Objectives:

To develop a radiographic fracture scoring system for lateral compression type 1 (LC-1) pelvic fractures based on OTA/AO survey data and to preliminarily evaluate this system within an LC-1 pelvis fracture cohort.

Design:

Survey study with validation patient cohort.

Setting:

Two Level 1 academic trauma centers.

Patients/Participants:

Attendings (n=111) at the 2013 OTA/AO national meeting reviewed imaging from 27 LC-1 fractures and indicated surgical recommendations (“yes/no”). A separate LC-1 fracture cohort (33 patients) was used to evaluate the scoring system.

Intervention:

The LC-1 scoring system (range: 5–14) based on radiographic morphology of sacral, superior ramus (SR), and inferior ramus (IR) fracture components.

Main Outcome Measurement:

Numeric scores were compared against (1) OTA/AO attendees' operative recommendations and (2) LC-1 cohort treatment and outcomes.

Results:

Operative tendency of OTA/AO survey respondents—defined as the percent of “yes” responses to recommend surgical stabilization—was highly correlated with radiographic findings: sacral displacement {odds ratio (OR) = 18.9 [95% confidence interval (CI): 11.7–30.6]}; sacral column 2–3 versus 1 [OR = 5.7 (95% CI: 3.9–8.3)]; Denis classification [OR = 10 (95% CI: 6.7–14.9); IR displacement OR = 3.4 (95% CI: 2.3–4.8)]; and SR fracture [OR = 1.9 (95% CI: 1.3–2.8)]. Total scores <7 were 81% accurate in predicting nonoperative treatment. Total scores >9 were 89% accurate in predicting an operative recommendation. In the LC-1 cohort, scoring accuracy was 100% (95% CI: 85%–100%).

Conclusions:

Based on survey results and patient cohort data, scores <7 predict nonoperative treatment recommendation, scores >9 indicate surgical recommendations, and scores 7–9 indicate indeterminate stability that should be further evaluated.

Secondary Logo

Journal Logo

Validated Radiographic Scoring System for Lateral Compression Type 1 Pelvis Fractures