Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2022; 13(8): 744-752
Published online Aug 18, 2022. doi: 10.5312/wjo.v13.i8.744
Epidemiology of pelvic and acetabular fractures across 12-mo at a level-1 trauma centre
Rory Cuthbert, Samuel Walters, David Ferguson, Edward Karam, Jonathan Ward, Homa Arshad, Paul Culpan, Peter Bates
Rory Cuthbert, Samuel Walters, David Ferguson, Edward Karam, Jonathan Ward, Homa Arshad, Paul Culpan, Peter Bates, Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, London E1 1BB, United Kingdom
Author contributions: Cuthbert R designed the research study, performed data acquisition, and wrote the manuscript; Walters S, Ferguson D and Karam E designed the research study and performed data acquisition; Ward J, Arshad A, Culpan P and Bates P contributed towards conception of the study and final editing; all authors revised the article critically for important intellectual content, and provided final approval for the paper to be published.
Institutional review board statement: The NHS Research Ethics Committee decision tool excluded need for ethical review as this was a retrospective observational study.
Informed consent statement: Informed consent was not required for the above study as data was collected retrospectively and anonymized.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rory Cuthbert, BSc, MBBS, Surgeon, Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health, Royal London Hospital, Barts Health, Whitechapel, London, E1 1BB, United Kingdom. rory.cuthbert@nhs.net
Received: December 18, 2021
Peer-review started: December 18, 2021
First decision: January 25, 2022
Revised: February 7, 2022
Accepted: July 22, 2022
Article in press: July 22, 2022
Published online: August 18, 2022
Abstract
BACKGROUND

Despite motor-vehicle safety advancements and increasingly rigorous workplace safety regulations, trauma/suicide remains the leading cause of death under the age of 45 in the United Kingdom. To promote centralisation of care and optimisation of major trauma outcomes, in 2012 the National Health Service introduced the Trauma Network System. To our knowledge, this is the first study to analyse the epidemiology of pelvic and acetabular trauma over a one-year period at a level-1 trauma centre in the United Kingdom, since nationwide introduction of the Trauma Network System.

AIM

To characterize the epidemiology of high-energy pelvic and acetabular fractures over a one-year period at a level-1 trauma centre, and explore both resources required to care for these patients and opportunities for future research and injury prevention initiatives.

METHODS

227 consecutive patients at a level-1 trauma centre with pelvic and acetabular fractures were analysed between December 2017-December 2018. Paediatric patients (< 18 years) and fragility fractures were excluded, leaving 175 patients for inclusion in the study. Statistical analysis was performed using Fisher’s exact test for categorical variables.

RESULTS

72% of pelvic and acetabular fractures occurred in male patients at a median age of 45 years. 15% were the result of a suicide attempt. 48% of patients required pelvic or acetabular surgery, with 38% undergoing further surgery for additional orthopaedic injuries. 43% of patients were admitted to intensive care. The median inpatient stay was 13 days, and the 30- day mortality was 5%. Pelvic ring trauma was more commonly associated with abdominal injury (P = 0.01) and spine fractures (P < 0.001) than acetabular fractures. Vertical shear pelvic ring fractures were associated with falls (P = 0.03) while lateral compression fractures were associated with road traffic accidents (P = 0.01).

CONCLUSION

High energy pelvic and acetabular fractures are associated with concomitant orthopaedic fractures (most commonly spine and lower limb), intensive care admission and prolonged inpatient stays. Most pelvic ring injuries secondary to road traffic accidents are lateral compression type, demonstrating the need for future research to drive advancements in lateral impact vehicle safety along with mental health surveillance for those deemed to be potential suicide risks.

Keywords: Pelvis, Acetabulum, Orthopedics, Multiple trauma, Trauma centers

Core Tip: To our knowledge, this is the first study to analyze the epidemiology of pelvic and acetabular trauma over a one-year period at a level-1 trauma centre in the United Kingdom since introduction of the Trauma Network System. This study demonstrates pelvic and acetabular fractures are associated with concomitant orthopaedic fractures (commonly spine and lower limb), intensive care admission and lengthy inpatient stays. Future injury prevention research should focus on advancements in lateral impact vehicle safety alongside mental health surveillance for patients deemed to be potential suicide risks.