Journal of orthopaedic trauma · 2025
Percutaneous Anterior Pelvic Ring Fixation in Addition to Percutaneous Posterior Pelvic Ring Fixation Decreases Postoperative Pain and Narcotic Usage in Hospital for Lateral Compression Types 1 and Lateral Compression Type 2 Injuries.
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Kumaran Pranit, Wier Julian, Patterson Joseph T, Lee Jackson, Marecek Geoffrey, Lee Adam, Gary Joshua L
Аннотация
OBJECTIVES: To compare postoperative pain and opioid requirements between lateral compression types 1 (LC1) and lateral compression type 2 (LC2) injuries treated with anterior and posterior fixation (PF) [anterior fixation (AF) + PF] versus PF only.
DESIGN: Retrospective review of propensity matched cohorts for sex, age, LC1 versus LC2, sacral fracture type, and preoperative Visual Analogue Scale (VAS) pain scores were created in a 1:1 ratio.
SETTING: Level 1 trauma center and academic tertiary care hospital.
PATIENT SELECTION CRITERIA: Adult patients with LC1 or LC2 (OTA/AO 61B2.1, 61B2.2) injuries treated surgically with PF or AF + PF between March 2019 through January 2024.
OUTCOME MEASURES AND COMPARISONS: VAS and morphine milligram equivalents (MMEs) were measured at 24 and 48 hours postoperatively, and 24 hours before discharge between the groups. Secondary outcomes included postoperative days to mobilization (DTM) and length of stay.
RESULTSINTOTAL,: 56 patients (28 AF + PF, mean age 49.4 ± 16.9, 57.1% female, 28 PF, mean age 49.8 ± 16.9, 53.6% female) were included. There were no differences between the groups for demographic data (all P > 0.78). Patients with AF + PF had lower VAS scores than patients with PF 24 hours postoperatively [difference in mean (DIM): 2.18 cm (95% confidence interval (95% CI): 0.9068-3.4532], P = 0.001), 48 hours postoperatively [DIM: 3.43 cm (95% CI: 2.11 to 4.75), P < 0.001] and 24 hours before discharge [DIM: 2.68 (95% CI: 1.31 to 4.04), P < 0.001]. Patients with AF + PF required lower MMEs 24 hours before discharge [DIM: 6.989 (95% CI: 0.873 to 13.105), P = 0.026]. Patients with AF + PF also had shorter DTM [DIM: 3.21 (95% CI: 0.03 to 6.40), P = 0.048]. There were no differences in MMEs 24 hours postoperatively [DIM: 3.64 (95% CI: -4.15 to 11.44), P = 0.35], 48 hours postoperatively [DIM: 4.78 (95% CI: -3.12 to 12.67), P = 0.23], or length of stay [DIM: 1.96 (95% CI: -2.03 to 5.95), P = 0.33].
CONCLUSIONS: Anterior and posterior fixation was associated with significantly decreased inpatient postoperative pain, predischarge narcotics use, and DTM compared with PF alone. The combination of percutaneous AF and PF for LC1 and LC2 pelvic ring injuries should be considered when the goals are maximizing pain control.
LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Retrospective review of propensity matched cohorts for sex, age, LC1 versus LC2, sacral fracture type, and preoperative Visual Analogue Scale (VAS) pain scores were created in a 1:1 ratio.
SETTING: Level 1 trauma center and academic tertiary care hospital.
PATIENT SELECTION CRITERIA: Adult patients with LC1 or LC2 (OTA/AO 61B2.1, 61B2.2) injuries treated surgically with PF or AF + PF between March 2019 through January 2024.
OUTCOME MEASURES AND COMPARISONS: VAS and morphine milligram equivalents (MMEs) were measured at 24 and 48 hours postoperatively, and 24 hours before discharge between the groups. Secondary outcomes included postoperative days to mobilization (DTM) and length of stay.
RESULTSINTOTAL,: 56 patients (28 AF + PF, mean age 49.4 ± 16.9, 57.1% female, 28 PF, mean age 49.8 ± 16.9, 53.6% female) were included. There were no differences between the groups for demographic data (all P > 0.78). Patients with AF + PF had lower VAS scores than patients with PF 24 hours postoperatively [difference in mean (DIM): 2.18 cm (95% confidence interval (95% CI): 0.9068-3.4532], P = 0.001), 48 hours postoperatively [DIM: 3.43 cm (95% CI: 2.11 to 4.75), P < 0.001] and 24 hours before discharge [DIM: 2.68 (95% CI: 1.31 to 4.04), P < 0.001]. Patients with AF + PF required lower MMEs 24 hours before discharge [DIM: 6.989 (95% CI: 0.873 to 13.105), P = 0.026]. Patients with AF + PF also had shorter DTM [DIM: 3.21 (95% CI: 0.03 to 6.40), P = 0.048]. There were no differences in MMEs 24 hours postoperatively [DIM: 3.64 (95% CI: -4.15 to 11.44), P = 0.35], 48 hours postoperatively [DIM: 4.78 (95% CI: -3.12 to 12.67), P = 0.23], or length of stay [DIM: 1.96 (95% CI: -2.03 to 5.95), P = 0.33].
CONCLUSIONS: Anterior and posterior fixation was associated with significantly decreased inpatient postoperative pain, predischarge narcotics use, and DTM compared with PF alone. The combination of percutaneous AF and PF for LC1 and LC2 pelvic ring injuries should be considered when the goals are maximizing pain control.
LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.