Classification of pelvic ring fractures in skeletonized human remains.

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Abstract

[Indexed for MEDLINE] 9. Eur J Orthop Surg Traumatol. 2026 May 30;36(1):202. doi: 10.1007/s00590-026-04744-8. Examination under anesthesia imaging changes surgeons' classification and treatment decisions of anterior posterior compression pelvic ring injuries. Therrien CC(1), Ten Duis K(2), Aprato A(3), Banierink H(2), Bastian JD(4), Höch A(5), Mezzadri UMR(6), van Oldenrijk J(7), Pieroh P(5), Sagi HC(8), de Vries JPM(9), Reininga IHF(2), IJpma FFA(2); Society of European Pelvic and Acetabulum Surgeons. Collaborators: Razak KAA, Addevico F, Alotheri Y, Andrés-Peiró JV, Arand C, Atan AA, van Baal MCPM, Barreca S, Bastian JD, Bates P, Bijlsma T, Bolierakis E, Boluda-Mengod J, Boudissa M, Bove F, Bransen J, Buteau P, Casiraghi A, Cattaneo S, Chiodini F, Wagner FC, Colonna C, Cretnik A, De Biase P, Duis KT, Edwards MJR, van Embden D, Erdle B, Franke J, Fratus A, Fu-Xiang PK, Gamulin A, Gänsslen A, Geeraedts LMG Jr, Gilli A, Giráldez-Sánchez MÁ, Hagenaars T, Hartel M, van Helden S, Herath SC, Hermans E, Herteleer M, Hinz N, Höch A, Hogervorst M, Horst K, Ibarzábal-Gil A, IJpma FFA, Burgos EJ, Junaidi MA, Kanakaris N, Kleber C, Lehmann W, Link BC, Liodakis E, Lo Re D, Louka JG, De Luca L, Madsen JE, Märdian S, Mario A, Materazzi G, Maurizio A, van Meirhaeghe JP, Meylaerts SA, Mezzadri UMR, Molenaers B, Moretti A, Movcans J, Muñoz-Vives JM, Muslim MYBA, Nijveldt RJ, Notov D, van Oldenrijk J, Olías-López B, Osterhoff G, Pantè S, Pascarella R, Pfeifer R, Pieroh P, Plomp RG, Pohlemann T, Poinot N, Ponsen KJ, Putzeys G, De Ridder VA, Rommens PM, De Roo PJ, Santavicca M, Santolini E, Schipper IB, Schweigkofler U, Stibor M, van Stigt SFL, Stirler V, Tatiana C, Teixidor-Serra J, Teuben MPJ, Thannheimer A, Thomas F, Torrejón A, Varghese VD, Verbruggen J, Vergano LB, Videla F, van Wageningen B, Wagner D, van der Zwaal P. Author information: (1)Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands. c.c.therrien@umcg.nl. (2)Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands. (3)Department of Orthopaedics, University of Turin, Turin, Italy. (4)Department of Orthopaedic Surgery and Traumatology, University Hospital of Bern, Bern, Switzerland. (5)Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany. (6)Department of Orthopaedic and Trauma Surgery, ASST GOM Niguarda, Milan, Italy. (7)Department of Orthopaedics and Sports Medicine, Erasmus MC, Rotterdam, Netherlands. (8)Department of Orthopedic Surgery and Sports Medicine, University of Cincinnati, Cincinnati, United States. (9)Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands. PURPOSE: To report on the effect that Pelvic Examination Under Anesthetic (EUA) has on modifying both the classification and treatment plan for Tile-B, Anterior Posterior Compression (APC) injuries. METHODS: Four hundred international pelvic surgeons were invited to participate in a two-part online survey. Each of the two surveys included the same ten cases selected to represent a spectrum of APC injuries, with the first survey containing only pre-operative static radiographic and CT imaging, and the second survey including the additional EUA images. Surgeons were asked to answer questions regarding classification and treatment. RESULTS: One hundred twenty-three pelvic surgeons participated (response rate = 31%). Respondents were primarily trauma surgeons (76%) from level 1 trauma centers (82%), with an average of ten (IQR 5-15) years of experience in treating pelvic injuries. The addition of EUA imaging resulted in 46% of the respondents in a change in classification, primarily shifting from APC1 (26% with static imaging to 17% with EUA imaging) to APC2 (57% to 67%). Treatment decisions changed in 36% of responses: non-operative management decreased from 15% to 7%, and anterior-only fixation increased from 22% to 35%. CONCLUSION: The addition of EUA images in external rotation pelvic ring injuries altered almost half of the surgeons' perceptions of the classification (46%) and-more importantly-over one-third (36%) of the surgeons' treatment plans. The addition of the EUA imaging had its most significant impact on revising injuries initially classified as APC1, indicating an underestimation of injury severity in this group. However, these changes varied widely across the representative injuries, with EUA serving as a confirmatory tool in some cases, while revealing occult instability in others. © 2026. The Author(s). DOI: 10.1007/s00590-026-04744-8 PMCID: PMC13222183