Standard Practice in Treatment of Unstable Pelvic Ring Injuries: Results of an International Survey

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

Methods: A standardized questionnaire was developed by experts from the SICOT-Trauma committee (Société Internationale de Chirurgie Orthopédique et de Traumatologie) and then distributed among members. Topics in the questionnaire included treatment strategies, classification, staging procedures, and preoperative planning. Answer options for treatment strategies were ranked on a 4-point Likert scale: (1) Always (A), (2) Often (O), (3) Seldom (S), and (4) Never (N). Stratification was performed according to geographic regions.

Results: The survey was conducted online for approximately 1 month in 2022, with 358 experienced trauma surgeons encompassing 82 countries (experience >5 years = 79%) responding. In regards to classification system utilized, The Young and Burgess (52%) and Tile/AO (47%) classifications were the most commonly used. Rescue screws (RS), C-clamps (CC), and angioembolization (AE) were observed to be readily implemented in practice (A + O: RS = 24%, CC = 25%, AE = 21%). Percutaneous techniques were indicated to be regularly utilized (A + O) in 57%, whereas 65% of the respondents indicated never using navigated techniques. External fixation was reported as a frequently performed technique (A + O=71%). Pelvic packing was reported as seldomly or never used by 47% and 28% of of respondents, respectively. Resuscitative endovascular balloon occlusion of the aorta (REBOA) appeared to have a geographically skewed distribution in use, with more reported use in Europe (19%) and North America (10%), whereas 68% of respondents in other regions never use REBOA. With regard to imaging, 93% of participating surgeons indicated they utilized preoperative 3D CT scans.

Conclusion: The current internationally distributed survey study is the first to identify regional differences and global similarities in treatment strategies of unstable pelvic ring injuries in this extent. Our survey seemed to highlight pronounced regional differences in utilization of augmented techniques. Due to severity of pelvic ring injuries and the sequalae, standardization of treatment and international consensus in treatment algorithms would benefit both treatment teams and patients in management of these challenging injuries.