OF-Pelvis classification of osteoporotic sacral and pelvic ring fractures.

Humans Observer Variation Pelvic Bones / diagnostic imaging Pelvis Reproducibility of Results Sacrum / diagnostic imaging

Classification Consensus development Fracture Osteoporosis Pelvic ring Reliability Sacral

Journal

BMC musculoskeletal disorders

ISSN: 1471-2474

Titre abrégé: BMC Musculoskelet Disord

Pays: England

ID NLM: 100968565

Informations de publication

Date de publication:
29 Nov 2021

Historique:

received: 10 07 2021

accepted: 16 11 2021

entrez: 30 11 2021

pubmed: 1 12 2021

medline: 15 12 2021

Statut: epublish

Résumé

Osteoporotic fractures of the pelvis (OFP) are an increasing issue in orthopedics. Current classification systems (CS) are mostly CT-based and complex and offer only moderate to substantial inter-rater reliability (interRR) and intra-rater reliability (intraRR). MRI is thus gaining importance as a complement. This study aimed to develop a simple and reliable CT- and MRI-based CS for OFP. A structured iterative procedure was conducted to reach a consensus among German-speaking spinal and pelvic trauma experts over 5 years. As a result, the proposed OF-Pelvis CS was developed. To assess its reliability, 28 experienced trauma and orthopedic surgeons categorized 25 anonymized cases using X-ray, CT, and MRI scans twice via online surveys. A period of 4 weeks separated the completion of the first from the second survey, and the cases were presented in an altered order. While 13 of the raters were also involved in developing the CS (developing raters (DR)), 15 user raters (UR) were not deeply involved in the development process. To assess the interRR of the OF-Pelvis categories, Fleiss' kappa (κ The OF-Pelvis consists of five subgroups and three modifiers. Instability increases from subgroups 1 (OF1) to 5 (OF5) and by a given modifier. The three modifiers can be assigned alone or in combination. In both surveys, the interRR for subgroups was substantial: κ The OF-Pelvis is a reliable tool to categorize OFP with substantial interRR and almost perfect intraRR. The similar reliabilities between experienced DRs and URs demonstrate that the training status of the user is not important. However, it may be a reliable basis for an indication of the treatment score.

Identifiants

DOI: 10.1186/s12891-021-04882-6 PMID: 34844577 PMC: PMC8630873

pubmed: 34844577

doi: 10.1186/s12891-021-04882-6

pii: 10.1186/s12891-021-04882-6

pmc: PMC8630873

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

992

Informations de copyright

Références

Lourie H. Spontaneous osteoporotic fracture of the sacrum: an unrecognized syndrome of the elderly. Jama. 1982;248(6):715–7.

doi: 10.1001/jama.1982.03330060055034

Breuil V, Roux CH, Carle GF. Pelvic fractures: epidemiology, consequences, and medical management. Curr Opin Rheumatol. 2016;28(4):442–7.

doi: 10.1097/BOR.0000000000000293

Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury. 2013;44(12):1733–44. https://doi.org/10.1016/j.injury.2013.06.023 .

doi: 10.1016/j.injury.2013.06.023 pubmed: 23871193

Bakker G, Hattingen J, Stuetzer H, Isenberg J. Sacral insufficiency fractures: how to classify? J Korea Neurosurg Soc. 2018;61(2):258.

doi: 10.3340/jkns.2017.0188

Vaccaro AR, Schroeder GD, Divi SN, Kepler CK, Kleweno CP, Krieg JC, et al. Description and reliability of the AOSpine sacral classification system. J Bone Joint Surg Am. 2020;102(16):1454.

doi: 10.2106/JBJS.19.01153

Krappinger D, Kaser V, Merkel A, Neururer S, Lindtner RA. An alphanumeric classification of osteoporotic pelvic ring injuries. Arch Orthop Trauma Surg. 2020:1–9.

Nuchtern JV, Hartel MJ, Henes FO, Groth M, Jauch SY, Haegele J, et al. Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring fractures. Injury. 2015;46(2):315–9. https://doi.org/10.1016/j.injury.2014.10.050 .

doi: 10.1016/j.injury.2014.10.050 pubmed: 25527459

Mendel T, Ullrich BW, Hofmann GO, Schenk P, Goehre F, Schwan S, et al. Progressive instability of bilateral sacral fragility fractures in osteoporotic bone: a retrospective analysis of X-ray, CT, and MRI datasets from 78 cases. Eur J Trauma Emerg Surg. 2020:1–9.

Graul I, Marintschev I, Hackenbroch C, Palm H-G, Friemert B, Lang P. Modified therapy concepts for fragility fractures of the pelvis after additional MRI. PLoS One. 2020;15(10):e0238773.

doi: 10.1371/journal.pone.0238773

Mendel T, Schenk P, Ullrich BW, Hofmann GO, Goehre F, Schwan S, et al. Mid-term outcome of bilateral fragility fractures of the sacrum after bisegmental transsacral stabilization versus spinopelvic fixation. The Bone & Joint Journal. 2021;103-B(3):462–8. https://doi.org/10.1302/0301-620x.103b3.bjj-2020-1454.r1 .

doi: 10.1302/0301-620x.103b3.bjj-2020-1454.r1

Spiegl UJA, Schnake KJ, Osterhoff G, Scheyerer MJ, Ullrich B, Bula P, et al. Imaging of sacral stress and insufficiency fractures. Z Orthop Unfall. 2019;157(2):144–53. https://doi.org/10.1055/a-0640-8933 .

doi: 10.1055/a-0640-8933 pubmed: 30053762

Schnake KJ, Blattert TR, Hahn P, Franck A, Hartmann F, Ullrich B, et al. Classification of osteoporotic thoracolumbar spine fractures: recommendations of the spine section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J. 2018;8(2_suppl):46S–9S.

doi: 10.1177/2192568217717972

Audige L, Bhandari M, Hanson B, Kellam J. A concept for the validation of fracture classifications. J Orthop Trauma. 2005;19(6):401–6.

pubmed: 16003200

Mendel T, Noser H, Kuervers J, Goehre F, Hofmann G, Radetzki F. The influence of sacral morphology on the existence of secure S1 and S2 transverse bone corridors for iliosacroiliac screw fixation. Injury. 2013;44(12):1773–9.

doi: 10.1016/j.injury.2013.08.006

Kepler CK, Vaccaro AR, Koerner JD, Dvorak MF, Kandziora F, Rajasekaran S, et al. Reliability analysis of the AOSpine thoracolumbar spine injury classification system by a worldwide group of naïve spinal surgeons. Eur Spine J. 2016;25(4):1082–6. https://doi.org/10.1007/s00586-015-3765-9 .

doi: 10.1007/s00586-015-3765-9 pubmed: 25599849

Landis JR, Koch GG. The measurement of observer agreement for categorical data. biometrics. 1977:159–74. https://doi.org/10.2307/2529310 .

Rommens P, Arand C, Hopf J, Mehling I, Dietz S, Wagner D. Progress of instability in fragility fractures of the pelvis: an observational study. Injury. 2019;50(11):1966–73.

doi: 10.1016/j.injury.2019.08.038

Krappinger D, Kaser V, Kammerlander C, Neuerburg C, Merkel A, Lindtner RA. Inter-and intraobserver reliability and critical analysis of the FFP classification of osteoporotic pelvic ring injuries. Injury. 2019;50(2):337–43.

doi: 10.1016/j.injury.2018.11.027

Rommens PM, Ossendorf C, Pairon P, Dietz S-O, Wagner D, Hofmann A. Clinical pathways for fragility fractures of the pelvic ring: personal experience and review of the literature. J Orthop Sci. 2015;20(1):1–11.

doi: 10.1007/s00776-014-0653-9

Wagner D, Ossendorf C, Gruszka D, Hofmann A, Rommens P. Fragility fractures of the sacrum: how to identify and when to treat surgically? Eur J Trauma Emerg Surg. 2015;41(4):349–62.

doi: 10.1007/s00068-015-0530-z

Rommens PM, Wagner D, Hofmann A. Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis. Chirurgia (Bucharest, Romania: 1990). 2017;112(5):524–37.

doi: 10.21614/chirurgia.112.5.524

Cabarrus MC, Ambekar A, Lu Y, Link TM. MRI and CT of insufficiency fractures of the pelvis and the proximal femur. Am J Roentgenol. 2008;191(4):995–1001.

doi: 10.2214/AJR.07.3714

Lyders E, Whitlow C, Baker M, Morris P. Imaging and treatment of sacral insufficiency fractures. Am J Neuroradiol. 2010;31(2):201–10.

doi: 10.3174/ajnr.A1666

Henes FO, Nuchtern JV, Groth M, Habermann CR, Regier M, Rueger JM, et al. Comparison of diagnostic accuracy of magnetic resonance imaging and multidetector computed tomography in the detection of pelvic fractures. Eur J Radiol. 2012;81(9):2337–42. https://doi.org/10.1016/j.ejrad.2011.07.012 .

doi: 10.1016/j.ejrad.2011.07.012 pubmed: 21924851

Palm H-G, Lang P, Hackenbroch C, Sailer L, Friemert B. Dual-energy CT as an innovative method for diagnosing fragility fractures of the pelvic ring: a retrospective comparison with MRI as the gold standard. Arch Orthop Trauma Surg. 2020;140(4):473–80.

doi: 10.1007/s00402-019-03283-8

Vleeming A, Schuenke M, Masi A, Carreiro J, Danneels L, Willard F. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat. 2012;221(6):537–67.

doi: 10.1111/j.1469-7580.2012.01564.x

Pieroh P, Höch A, Hohmann T, Gras F, Märdian S, Pflug A, et al. Fragility fractures of the pelvis classification: a multicenter assessment of the intra-rater and inter-rater reliabilities and percentage of agreement. JBJS. 2019;101(11):987–94.

doi: 10.2106/JBJS.18.00930

Reinhold M, Audige L, Schnake KJ, Bellabarba C, Dai LY, Oner FC. AO spine injury classification system: a revision proposal for the thoracic and lumbar spine. Eur Spine J. 2013;22(10):2184–201. https://doi.org/10.1007/s00586-013-2738-0 .

doi: 10.1007/s00586-013-2738-0 pubmed: 23508335 pmcid: 3804719

Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine. 2013;38(23):2028–37.

doi: 10.1097/BRS.0b013e3182a8a381

Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg British. 1989;71(2):304–6.

doi: 10.1302/0301-620X.71B2.2925751

Meccariello L, Razzano C, De Dominicis C, Herrera-Molpeceres JA, Liuzza F, Erasmo R, et al. A new prognostic pelvic injury outcome score. Medicinski Glasnik. 2021;18(1).