Skip to main content

Advertisement

SpringerLink
Log in

Additional clinical value of routine CT imaging in fragility fractures of the pelvis: a prospective cohort study (ARTIFACT)

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Additional CT imaging for fragility fractures of the pelvis (FFP) has a high detection rate for concomitant posterior ring fractures (cPRFs). However, the clinical value of routine additional CT imaging is unknown. This study aimed to determine the additional clinical value of routine CT imaging by changes in treatment policy and to establish the predictive value of pain localized around the sacroiliac joint (SIJ) for cPRFs.

Methods

A prospective cohort study was conducted in a single teaching hospital in the Netherlands between November 2019 and November 2020. Patients were included if they were ≥ 65 years and had a (suspected) FFP on the pelvic radiograph. All patients underwent additional CT imaging. Changes in treatment policies ((possible) surgery, restrictive weight-bearing, hospital admission and outpatient follow-up) after CT imaging were registered.

Results

Fifty-one patients (44 female) were included with a mean age of 80.6 years. Routine CT imaging revealed an additional cPRF in 27 patients (53%). A change in treatment occurred in 29 patients (57%), of which 7 (12%) were managed either surgical or with restrictive weight-bearing. The presence of pain around the SIJ had a sensitivity of 89% and specificity of 61% for detecting a cPRF.

Conclusion

Routine additional CT imaging has few direct therapeutic consequences with regards to surgical management or restrictive weight-bearing. These findings may be altered when considering a lower threshold for surgical intervention. The presence of pain around the SIJ was highly predictive for a clinically relevant cPRF.

Trial registration

NL8011 on 02–09–2019.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of data and materials

The data that support the findings of this study are available from the corresponding author on request.

References

  1. Rommens PM, Wagner D, Hofmann A. Fragility fractures of the pelvis. JBJS Reviews. 2017;5(3)

  2. van Dijk WA, Poeze M, van Helden SH, Brink PRG, Verbruggen JPAM. Ten-year mortality among hospitalised patients with fractures of the pubic rami. Injury. 2010;41(4):411–4.

    Article  PubMed  Google Scholar 

  3. Höch A, Özkurtul O, Pieroh P, Josten C, Böhme J. Outcome and 2-year survival rate in elderly patients with lateral compression fractures of the pelvis. Geriatric Orthopaedic Surg Rehabil. 2017;8(1):3–9.

    Article  Google Scholar 

  4. Reito A, Kuoppala M, Pajulammi H, Hokkinen L, Kyrölä K, Paloneva J. Mortality and comorbidity after non-operatively managed, low-energy pelvic fracture in patients over age 70: A comparison with an age-matched femoral neck fracture cohort and general population. BMC Geriatrics. 2019;19(1)

  5. Loggers SAI, Joosse P, Jan PK. Outcome of pubic rami fractures with or without concomitant involvement of the posterior ring in elderly patients. Eur J Trauma Emerg Surg. 2019;45(6):1021–9.

    Article  PubMed  Google Scholar 

  6. Babayev M, Lachmann E, Nagler. The controversy surrounding sacral insufficiency fractures: to ambulate or not to ambulate? Am J Phys Med Rehabil. 2000;79(4):404–9.

  7. Morghen S, Morandi A, Guccione AA, Bozzini M, Guerini F, Gatti R, et al. The association between patient participation and functional gain following inpatient rehabilitation. Aging Clin Exp Res. 2017;29(4):729–36.

    Article  PubMed  Google Scholar 

  8. Peh WCG, Khong PL, Ho WY, Yeung HWD, Luk KDK, Orth M. Sacral insufficiency fractures spectrum of radiological features Clinical Imaging. 1995;19(2):92–101.

  9. Wagner D, Ossendorf C, Gruszka D, Hofmann A, Rommens PM. Fragility fractures of the sacrum: how to identify and when to treat surgically? Eur J Trauma Emerg Surg Springer, Berlin. 2015;41:349–62.

    Article  CAS  Google Scholar 

  10. 2019–01 Rommens, When and How to Operate Fragility Fractures of the Pelvis

  11. Küper MA, Trulson A, Stuby FM, Stöckle U. Pelvic ring fractures in the elderly. EFORT Open Rev. 2019;6:313–20.

    Article  Google Scholar 

  12. Studer P, Suhm N, Zappe B, Bless N, Jakob M. Pubic rami fractures in the elderly - A neglected injury? Swiss Medical Weekly. 2013;143

  13. Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment. Injury. 2013;44(12):1733–44.

    Article  PubMed  Google Scholar 

  14. Schicho A, Schmidt SA, Seeber K, Olivier A, Richter PH, Gebhard F. Pelvic X-ray misses out on detecting sacral fractures in the elderly – Importance of CT imaging in blunt pelvic trauma. Injury. 2016;47(3):707–10.

    Article  PubMed  Google Scholar 

  15. Soles GLS, Ferguson TA. Fragility fractures of the pelvis. Curr Rev Musculoskelet Med. 2012;5(3):222–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sullivan MP, Baldwin KD, Donegan DJ, Mehta S, Ahn J. Geriatric fractures about the hip: Divergent patterns in the proximal femur, acetabulum, and pelvis. Orthopedics. 2014;37(3):151–7.

    Article  PubMed  Google Scholar 

  17. Nanninga GL, de Leur K, Panneman MJM, van der Elst M, Hartholt KA. Increasing rates of pelvic fractures among older adults: The Netherlands, 1986–2011. Age Ageing. 2014;43(5):648–53.

    Article  PubMed  Google Scholar 

  18. Alton TB, Gee AO. Classifications in brief: Young and Burgess classification of pelvic ring injuries. Clin Orthopaed Related Res Springer New York LLC. 2014;472:2338–42.

    Article  Google Scholar 

  19. Gericke L, Fritz A, Osterhoff G, Josten C, Pieroh P, Höch A. Percutaneous operative treatment of fragility fractures of the pelvis may not increase the general rate of complications compared to non-operative treatment. Eur. J. Trauma Emerg. Surg. 2021

  20. Osterhoff G, Noser J, Held U, Werner CML, Pape HC, Dietrich M. Early operative versus nonoperative treatment of fragility fractures of the pelvis: a propensity-matched multicenter study. J Orthop Trauma. 2019;33(11):e410–5.

    Article  PubMed  Google Scholar 

  21. Hotta K, Kobayashi T. Functional treatment strategy for fragility fractures of the pelvis in geriatric patients. Eur J Trauma Emerg Surg. 2021;47(1):21–7.

    Article  PubMed  Google Scholar 

  22. Nüchtern JV, Hartel MJ, Henes FO, Groth M, Jauch SY, Haegele J, et al. Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring fractures. Injury. 2015;46(2):315–9.

    Article  PubMed  Google Scholar 

  23. Alnaib M, Waters S, Shanshal Y, Caplan N, Jones S, et al. Combined pubic rami and sacral osteoporotic fractures: A prospective study. J Orthopaed Traumatol. 2012;13(2):97–103.

    Article  CAS  Google Scholar 

  24. Rommens PM, Arand C, Hopf JC, Mehling I, Dietz SO, Wagner D. Progress of instability in fragility fractures of the pelvis: An observational study. Injury. 2019;50(11):1966–73.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No funding to declare.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Northwest Clinics Alkmaar, Wilhelminalaan 12, 1815JD, Alkmaar, The Netherlands

    Gabrielle Willemijn Carolina Maria Beelen & Ditmar Schakenraad

  2. Department of Trauma Surgery, Northwest Clinics Alkmaar, Alkmaar, The Netherlands

    Sverre Arvid Ingemar Loggers, Pieter Joosse & Kees Jan Ponsen

  3. Department Radiology, Northwest Clinics Alkmaar, Alkmaar, The Netherlands

    Bart Willem Karel de Wit

  4. Department of Orthopedics, Northwest Clinics Alkmaar, Alkmaar, The Netherlands

    Dirk Jan Hofstee

Authors
  1. Gabrielle Willemijn Carolina Maria Beelen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sverre Arvid Ingemar Loggers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bart Willem Karel de Wit
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ditmar Schakenraad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dirk Jan Hofstee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pieter Joosse
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kees Jan Ponsen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gabrielle Willemijn Carolina Maria Beelen.

Ethics declarations

Conflict of interest

All the authors declare that they have no conflict of interest.

Ethics approval

Not applicable.

Code availability

Not applicable.

Consent to participate and for publication

Informed consent was obtained from all individual participants or proxy included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beelen, G.W.C.M., Loggers, S.A.I., de Wit, B.W.K. et al. Additional clinical value of routine CT imaging in fragility fractures of the pelvis: a prospective cohort study (ARTIFACT). Eur J Trauma Emerg Surg 48, 4713–4718 (2022). https://doi.org/10.1007/s00068-022-01989-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-022-01989-w

Keywords

Search

Navigation