Standard practice in treatment of unstable pelvic ring injuries – Results of an international questionnaire

Abstract text (incl. references and figure legends)

Introduction

Treatment protocol strategies for unstable pelvic ring injuries differ between institutions and regions. The aim of this international study was to identify treatment standards for unstable pelvic ring injuries.

Material & Methods

A standardized questionnaire was developed by experts from the SICOT-Trauma committee. This questionnaire was distributed to the members of the SICOT society. Topics were treatment strategies, classification, staging procedures and preoperative planning. Answer options for treatment strategies were: 1) Always (A), 2) Often (O), 3) Seldom (S), 4) Never (N). Stratification was performed according to geographic regions.

Results

358 experienced trauma surgeons from 83 countries (experience >5 years=79%) conducted the survey from 09/05/22 to 10/12/22. The Y&B (52%) and Tile/AO (47%) classifications were equally used. Rescue Screws (RS), C-Clamps (CC) and angioembolization (AE) are globally implemented in clinical practice (A+O: RS=24%, CC=25%, AE=21%). Percutaneous techniques are executed regularly (A+O) in 57%, whereas 65% of the respondents never use navigated techniques. External fixation is a frequently performed intervention worldwide (A+O=71%). Pelvic packing is globally not extensively implemented, as 28% never and 47% of surgeons seldom use it. REBOA is only utilized in specific continents. To be precise, in Europe/North America (A+O=19%/10%), whereas internationally 68% of participants never use REBOA. Only 7% of the respondents never perform preoperative 3D planning CT scanning.

Conclusion

The current international study is the first to identify regional differences and global similarities in treatment strategies of unstable pelvic ring injuries. Yet regional differences occur especially when it comes to more augmented techniques. New international consensus and standardized treatment guidelines are mandatory.

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