Advertisement

Pelvic fracture instability-associated L5 transverse process fracture, fact or myth? A systematic review and meta-analysis

  • Hazem Nasef
  • Ahmed Elhessy
  • Faris Abushaban
  • Abduljabbar AlhammoudEmail author
General Review • PELVIS - FRACTURES

Abstract

Purpose

Stable or unstable pelvic ring fractures are sometimes associated with L5 transverse process (TP) fractures. This review aimed to determine the effect of L5 TP fractures on pelvic ring fracture stability.

Methods

We searched electronic databases (including MEDLINE, Google Scholar, and SCOPUS) and performed hand searching of English orthopedics journals and conference abstracts until May 2017. We pooled data from five studies, with a total of 278 patients.

Results

Of 28 studies, five were included (four studies involved adult patients, one pediatric population). Of the 278 pelvic fractures (average age 37.33 years; male 132 and female 92), 99 (35.6%) were stable and 179 (64.4%) were unstable (fracture B and C, according to the Tile classification). Sixty-seven (24.1%) were cases with L5 TP, and 211 (75.9%) were cases without L5 TP fracture. The typical causes of injury were road traffic accident (59.2%), fall from height (23.6%), and crush injuries and injuries by heavy objects (17.2%). The pooled odds ratio (OR) of L5 TP between the stable and unstable groups calculated with random effect analysis was 0.418 (0.083–2.108; p = 0.291); after excluding the study on a pediatric population, the pooled OR was 0.349 (0.056–2.159; p = 0.258).

Conclusions

L5 TP fractures may indicate high-energy trauma; however, no relationship between L5 TP fractures and pelvic ring fracture stability exists.

Level of evidence

Prognostic Level IV.

Keywords

L5 transverse process fracture Pelvic ring fractures Stability 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

References

  1. 1.
    McCormack R, Strauss EJ, Alwattar BJ, Tejwani NC (2010) Diagnosis and management of pelvic fractures. Bull NYU Hosp Jt Dis 68:281–291PubMedGoogle Scholar
  2. 2.
    Tile M (1996) Acute pelvic fractures: I. Causation and classification. J Am Acad Orthop Surg 4:143–151CrossRefPubMedGoogle Scholar
  3. 3.
    Ismail HD, Lubis MF, Djaja YP (2016) The outcome of complex pelvic fracture after internal fixation surgery. Malays Orthop J 10:16–21.  https://doi.org/10.5704/MOJ.1603.004 PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Gänsslen A, Pohlemann T, Paul C et al (1996) Epidemiology of pelvic ring injuries. Injury 27(Suppl 1):S-A13–S-A20CrossRefGoogle Scholar
  5. 5.
    Miller CD, Blyth P, Civil ID (2000) Lumbar transverse process fractures—a sentinel marker of abdominal organ injuries. Injury 31:773–776CrossRefPubMedGoogle Scholar
  6. 6.
    Panic N, Leoncini E, de Belvis G et al (2013) Evaluation of the endorsement of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement on the quality of published systematic review and meta-analyses. PLoS ONE 8:e83138.  https://doi.org/10.1371/journal.pone.0083138 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Durkin A, Sagi HC, Durham R, Flint L (2006) Contemporary management of pelvic fractures. Am J Surg 192:211–223.  https://doi.org/10.1016/j.amjsurg.2006.05.001 CrossRefPubMedGoogle Scholar
  8. 8.
    Gabbe BJ, Esser M, Bucknill A et al (2013) The imaging and classification of severe pelvic ring fractures: experiences from two level 1 trauma centres. Bone Joint J 95-B:1396–1401.  https://doi.org/10.1302/0301-620X.95B10.32134 CrossRefPubMedGoogle Scholar
  9. 9.
    Hoffmeyer P, Seigne JM, Garcia J, Vasey H (1984) The value of computerized tomography in fractures of the pelvic ring. Int Orthop 8:1–8.  https://doi.org/10.1007/BF00267732 CrossRefPubMedGoogle Scholar
  10. 10.
    Khurana B, Sheehan SE, Sodickson AD, Weaver MJ (2014) Pelvic ring fractures: what the orthopedic surgeon wants to know. Radiogr Rev Publ Radiol Soc N Am Inc 34:1317–1333.  https://doi.org/10.1148/rg.345135113 CrossRefGoogle Scholar
  11. 11.
    Lee C, Porter K (2007) The prehospital management of pelvic fractures. Emerg Med J EMJ 24:130–133.  https://doi.org/10.1136/emj.2006.041384 CrossRefPubMedGoogle Scholar
  12. 12.
    Poenaru DV, Popescu M, Anglitoiu B et al (2015) Emergency pelvic stabilization in patients with pelvic posttraumatic instability. Int Orthop 39:961–965.  https://doi.org/10.1007/s00264-015-2727-5 CrossRefPubMedGoogle Scholar
  13. 13.
    Reis ND, Keret D (1985) Fracture of the transverse process of the fifth lumbar vertebra. Injury 16:421–423CrossRefPubMedGoogle Scholar
  14. 14.
    Chmelová J, Džupa V, Procházka B et al (2011) Fractures of the L5 transverse process in pelvic ring injury. Acta Chir Orthop Traumatol Cechoslov 78:46–48Google Scholar
  15. 15.
    Starks I, Frost A, Wall P, Lim J (2011) Is a fracture of the transverse process of L5 a predictor of pelvic fracture instability? J Bone Joint Surg Br 93:967–969.  https://doi.org/10.1302/0301-620X.93B7.26772 CrossRefPubMedGoogle Scholar
  16. 16.
    Maqungo S, Kimani M, Chhiba D et al (2015) The L5 transverse process fracture revisited. Does its presence predict the pelvis fracture instability? Injury 46:1629–1630.  https://doi.org/10.1016/j.injury.2015.04.039 CrossRefPubMedGoogle Scholar
  17. 17.
    Kenawey M, Krettek C, Addosooki A et al (2015) Unstable paediatric pelvic injuries: the patho-anatomical patterns of pelvic ring failure and the role of avulsion of the iliac apophysis. Bone Joint J 97-B:696–704.  https://doi.org/10.1302/0301-620X.97B5.35162 CrossRefPubMedGoogle Scholar
  18. 18.
    Pool-Goudzwaard A, Hoek van Dijke G, Mulder P et al (2003) The iliolumbar ligament: its influence on stability of the sacroiliac joint. Clin Biomech 18:99–105CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2017

Authors and Affiliations

  • Hazem Nasef
    • 1
  • Ahmed Elhessy
    • 1
  • Faris Abushaban
    • 2
  • Abduljabbar Alhammoud
    • 1
    Email author
  1. 1.Hamad Medical CorporationDohaQatar
  2. 2.Al Khor HospitalHamad Medical CorporationDohaQatar

Personalised recommendations