{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T23:13:06Z","timestamp":1791933186693,"version":"4.3.4"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"17","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2018,9,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Examination under anesthesia (EUA) has been used to identify pelvic instability. Surgeons may utilize percutaneous methods for posterior and anterior pelvic ring stabilization. We developed an intraoperative strategy whereby posterior fixation is performed, with reassessment using sequential EUA to determine the need for anterior fixation. Our aim in the current study was to evaluate whether this strategy reliably results in union with minimal displacement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This was a multicenter retrospective study involving adult patients with closed lateral compression (LC) pelvic ring injuries treated during the period of 2013 to 2016. Included were patients who underwent percutaneous pelvic fixation based on sequential EUA. Data points included patient demographics, injury and fixation details, and displacement as observed on follow-up radiographs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Complete documentation was available for 74 patients (mean age, 41 years). The mean duration of follow was 11 months. Fifty-three of the patients had LC-1 injuries, 19 had LC-2 injuries, and 2 had LC-3 injuries. Twenty-five (47.2%) of the 53 patients with LC-1 and 11 (57.9%) of the 19 patients with LC-2 injuries did not undergo anterior fixation on the basis of the algorithm. The 36 LC-1 or LC-2 patients who underwent combined anterior and posterior fixation had no measurable displacement at union. Of the 36 LC-1 or LC-2 patients with no anterior fixation, 27 with unilateral rami fractures had no measurable displacement at union. The remaining 9 LC-1 or LC-2 cases with no anterior fixation had bilateral superior and inferior rami fractures; each of these patients demonstrated displacement (mean, 7.5 mm; range, 5 to 12 mm) within 6 weeks of fixation that remained until union. All patients had protected weight-bearing for 12 weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A fixation strategy based on sequential intraoperative EUA reliably results in union with minimal displacement for unstable LC pelvic ring injuries. Injuries requiring combined anterior and posterior fixation healed with no displacement. Those without anterior fixation and a unilateral ramus fracture healed with no displacement. In the presence of bilateral rami fractures, even with a negative finding on sequential EUA, the pelvis healed with 7.5 mm average displacement. Surgeons may consider anterior fixation to prevent this displacement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.17.01650","type":"journal-article","created":{"date-parts":[[2018,9,5]],"date-time":"2018-09-05T15:43:10Z","timestamp":1536162190000},"page":"1503-1508","source":"Crossref","is-referenced-by-count":60,"title":["Fixation Strategy Using Sequential Intraoperative Examination Under Anesthesia for Unstable Lateral Compression Pelvic Ring Injuries Reliably Predicts Union with Minimal Displacement"],"prefix":"10.2106","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9365-1966","authenticated-orcid":false,"given":"Frank R.","family":"Avilucea","sequence":"first","affiliation":[{"name":"Orlando Health Orthopaedic Institute, Orlando, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4171-0303","authenticated-orcid":false,"given":"Michael T.","family":"Archdeacon","sequence":"additional","affiliation":[{"name":"University of Cincinnati Academic Health Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7148-2137","authenticated-orcid":false,"given":"Cory A.","family":"Collinge","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3081-9274","authenticated-orcid":false,"given":"Marcus","family":"Sciadini","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0365-6043","authenticated-orcid":false,"given":"H. Claude","family":"Sagi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0260-3468","authenticated-orcid":false,"given":"Hassan R.","family":"Mir","sequence":"additional","affiliation":[{"name":"University of South Florida\/Florida Orthopaedic Institute, Tampa, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,9,5]]},"reference":[{"key":"bib1-20230811","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1097\/00003086-198009000-00004","article-title":"Pelvic disruption: assessment and classification","volume":"151","author":"Pennal","year":"1980","journal-title":"Clin Orthop Relat Res."},{"key":"bib2-20230811","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/00003086-198009000-00014","article-title":"Results of treatment of acetabular fractures","volume":"151","author":"Pennal","year":"1980","journal-title":"Clin Orthop Relat Res."},{"issue":"2","key":"bib3-20230811","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/BF00350202","article-title":"Lateral compression fractures of the pelvis: the importance of plain radiographs in the diagnosis and surgical management","volume":"15","author":"Young","year":"1986","journal-title":"Skeletal Radiol."},{"issue":"2","key":"bib4-20230811","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1148\/radiology.160.2.3726125","article-title":"Pelvic fractures: value of plain radiography in early assessment and management","volume":"160","author":"Young","year":"1986","journal-title":"Radiology."},{"issue":"1","key":"bib5-20230811","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1097\/01.bot.0000202387.94504.f0","article-title":"Distraction external fixation in lateral compression pelvic fractures","volume":"20","author":"Bellabarba","year":"2006","journal-title":"J Orthop Trauma."},{"issue":"3","key":"bib6-20230811","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s00064-006-1173-3","article-title":"Percutaneous iliosacral screw fixation of unstable pelvic injuries by conventional fluoroscopy","volume":"18","author":"G\u00e4nsslen","year":"2006","journal-title":"Oper Orthop Traumatol."},{"issue":"3","key":"bib7-20230811","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1097\/00005131-200403000-00002","article-title":"Biomechanical analysis of fixation for vertically unstable sacroiliac dislocations with iliosacral screws and symphyseal plating","volume":"18","author":"Sagi","year":"2004","journal-title":"J Orthop Trauma."},{"issue":"7","key":"bib8-20230811","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1097\/00005131-200308000-00002","article-title":"Biomechanical comparison of posterior pelvic ring fixation","volume":"17","author":"Yinger","year":"2003","journal-title":"J Orthop Trauma."},{"issue":"4","key":"bib9-20230811","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1097\/00005131-200304000-00004","article-title":"S1 pediculoiliac screw fixation in instabilities of the sacroiliac complex: biomechanical study and report of two cases","volume":"17","author":"Sar","year":"2003","journal-title":"J Orthop Trauma."},{"issue":"6","key":"bib10-20230811","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1097\/00005131-200307000-00001","article-title":"Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure?","volume":"17","author":"Griffin","year":"2003","journal-title":"J Orthop Trauma."},{"issue":"4","key":"bib11-20230811","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1097\/00005131-200105000-00002","article-title":"Percutaneous stabilization of U-shaped sacral fractures using iliosacral screws: technique and early results","volume":"15","author":"Nork","year":"2001","journal-title":"J Orthop Trauma."},{"issue":"2","key":"bib12-20230811","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1097\/00005131-199902000-00007","article-title":"Early fixation of the vertically unstable pelvis: the role of iliosacral screw fixation of the posterior lesion","volume":"13","author":"Keating","year":"1999","journal-title":"J Orthop Trauma."},{"issue":"8","key":"bib13-20230811","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1097\/00005131-199711000-00007","article-title":"Iliosacral screw fixation: early complications of the percutaneous technique","volume":"11","author":"Routt","year":"1997","journal-title":"J Orthop Trauma."},{"key":"bib14-20230811","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/00003086-199608000-00016","article-title":"Internal fixation of unstable pelvic ring injuries","volume":"329","author":"Matta","year":"1996","journal-title":"Clin Orthop Relat Res."},{"issue":"8","key":"bib15-20230811","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/S0020-1383(96)00078-2","article-title":"The strength of iliosacral lag screws and transiliac bars in the fixation of vertically unstable pelvic injuries with sacral fractures","volume":"27","author":"Gorczyca","year":"1996","journal-title":"Injury."},{"key":"bib16-20230811","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1097\/00003086-199608000-00020","article-title":"Outcome after fixation of unstable posterior pelvic ring injuries","volume":"329","author":"Cole","year":"1996","journal-title":"Clin Orthop Relat Res."},{"issue":"3","key":"bib17-20230811","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/00005131-199506000-00005","article-title":"Early results of percutaneous iliosacral screws placed with the patient in the supine position","volume":"9","author":"Routt","year":"1995","journal-title":"J Orthop Trauma."},{"issue":"1","key":"bib18-20230811","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/0020-1383(94)90176-7","article-title":"The effect of thread length and location on extraction strengths of iliosacral lag screws","volume":"25","author":"Kraemer","year":"1994","journal-title":"Injury."},{"issue":"6","key":"bib19-20230811","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1097\/BOT.0b013e3181e47fad","article-title":"Transiliac-transsacral screws for posterior pelvic stabilization","volume":"25","author":"Gardner","year":"2011","journal-title":"J Orthop Trauma."},{"key":"bib20-20230811","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1097\/00003086-199608000-00011","article-title":"Indications for anterior fixation of pelvic fractures","volume":"329","author":"Matta","year":"1996","journal-title":"Clin Orthop Relat Res."},{"issue":"9","key":"bib21-20230811","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1097\/BOT.0b013e31822b02ae","article-title":"Examination under anesthetic for occult pelvic ring instability","volume":"25","author":"Sagi","year":"2011","journal-title":"J Orthop Trauma."},{"issue":"4","key":"bib22-20230811","first-page":"880","article-title":"Stress radiograph to detect true extent of symphyseal disruption in presumed anteroposterior compression type I pelvic injuries","volume":"69","author":"Suzuki","year":"2010","journal-title":"J Trauma."},{"issue":"1","key":"bib23-20230811","first-page":"159","article-title":"Displacement after simulated pelvic ring injuries: a cadaveric model of recoil","volume":"68","author":"Gardner","year":"2010","journal-title":"J Trauma."},{"issue":"6","key":"bib24-20230811","first-page":"325","article-title":"Effect of pelvic binder placement on OTA classification of pelvic ring injuries using computed tomography. Does it mask the injury?","volume":"30","author":"Swartz","year":"2016","journal-title":"J Orthop Trauma."},{"issue":"4","key":"bib25-20230811","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1097\/BOT.0000000000000766","article-title":"Negative stress examination under anesthesia reliably predicts pelvic ring union without displacement","volume":"31","author":"Whiting","year":"2017","journal-title":"J Orthop Trauma."},{"issue":"6","key":"bib26-20230811","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1097\/BOT.0b013e31817e49ee","article-title":"Comparative radiographic and clinical outcome of two-hole and multi-hole symphyseal plating","volume":"22","author":"Sagi","year":"2008","journal-title":"J Orthop Trauma."},{"issue":"8","key":"bib27-20230811","doi-asserted-by":"crossref","first-page":"2148","DOI":"10.1007\/s11999-012-2340-5","article-title":"Radiographic changes of implant failure after plating for pubic symphysis diastasis: an underappreciated reality?","volume":"470","author":"Collinge","year":"2012","journal-title":"Clin Orthop Relat Res."},{"key":"bib28-20230811","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/00003086-199608000-00004","article-title":"Assessment of pelvic ring stability after injury. Indications for surgical stabilization","volume":"329","author":"Olson","year":"1996","journal-title":"Clin Orthop Relat Res."},{"issue":"9","key":"bib29-20230811","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1097\/BOT.0b013e3181f8be33","article-title":"OTA highlight paper predicting future displacement of nonoperatively managed lateral compression sacral fractures: can it be done?","volume":"25","author":"Bruce","year":"2011","journal-title":"J Orthop Trauma."},{"issue":"3","key":"bib30-20230811","doi-asserted-by":"crossref","first-page":"143","DOI":"10.5435\/00124635-199605000-00004","article-title":"Acute pelvic fractures: I. Causation and classification","volume":"4","author":"Tile","year":"1996","journal-title":"J Am Acad Orthop Surg."},{"key":"bib31-20230811","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1097\/00003086-198009000-00009","article-title":"Pelvic disruption: principles of management","volume":"151","author":"Tile","year":"1980","journal-title":"Clin Orthop Relat Res."},{"issue":"9","key":"bib32-20230811","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.2106\/00004623-199173090-00017","article-title":"Lateral compression injury of the pelvis. A case report","volume":"73","author":"Gordon","year":"1991","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib33-20230811","doi-asserted-by":"crossref","first-page":"2104","DOI":"10.1007\/s11999-012-2364-x","article-title":"What are the patterns of injury and displacement seen in lateral compression pelvic fractures?","volume":"470","author":"Weaver","year":"2012","journal-title":"Clin Orthop Relat Res."},{"issue":"7","key":"bib34-20230811","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1097\/00005373-199007000-00015","article-title":"Pelvic ring disruptions: effective classification system and treatment protocols","volume":"30","author":"Burgess","year":"1990","journal-title":"J Trauma."},{"issue":"12","key":"bib35-20230811","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1097\/BOT.0000000000000133","article-title":"Operative agreement on lateral compression-1 pelvis fractures. a survey of 111 OTA members","volume":"28","author":"Beckmann","year":"2014","journal-title":"J Orthop Trauma."},{"issue":"1","key":"bib36-20230811","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/BOT.0b013e31818f8a81","article-title":"What constitutes a Young and Burgess lateral compression-I (OTA 61-B2) pelvic ring disruption? A description of computed tomography-based fracture anatomy and associated injuries","volume":"23","author":"Lefaivre","year":"2009","journal-title":"J Orthop Trauma."},{"issue":"4","key":"bib37-20230811","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.ocl.2004.06.004","article-title":"Instability of the posterior pelvic ring associated with disruption of the pubic symphysis","volume":"35","author":"Phieffer","year":"2004","journal-title":"Orthop Clin North Am."},{"key":"bib38-20230811","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/00003086-199608000-00015","article-title":"Closed reduction and percutaneous skeletal fixation of sacral fractures","volume":"329","author":"Routt","year":"1996","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib39-20230811","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/00005131-199502000-00006","article-title":"The retrograde medullary superior pubic ramus screw for the treatment of anterior pelvic ring disruptions: a new technique","volume":"9","author":"Routt","year":"1995","journal-title":"J Orthop Trauma."},{"issue":"2","key":"bib40-20230811","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1097\/BOT.0b013e318162ab6e","article-title":"Superior pubic ramus fractures fixed with percutaneous screws: what predicts fixation failure?","volume":"22","author":"Starr","year":"2008","journal-title":"J Orthop Trauma."},{"issue":"6","key":"bib41-20230811","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1097\/00005131-199412000-00004","article-title":"Internal fixation of the unstable anterior pelvic ring: a biomechanical comparison of standard plating techniques and the retrograde medullary superior pubic ramus screw","volume":"8","author":"Simonian","year":"1994","journal-title":"J Orthop Trauma."},{"issue":"8","key":"bib42-20230811","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1097\/00005131-199711000-00008","article-title":"Stability of open-book pelvic fractures using a new biomechanical model of single-limb stance","volume":"11","author":"MacAvoy","year":"1997","journal-title":"J Orthop Trauma."},{"issue":"11","key":"bib43-20230811","doi-asserted-by":"crossref","first-page":"944","DOI":"10.2106\/JBJS.15.00723","article-title":"Posterior fixation of APC-2 pelvic ring injuries decreases rates of anterior plate failure and malunion","volume":"98","author":"Avilucea","year":"2016","journal-title":"J Bone Joint Surg Am."},{"key":"bib44-20230811","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/00003086-198905000-00009","article-title":"Internal fixation of pelvic ring fractures","volume":"242","author":"Matta","year":"1989","journal-title":"Clin Orthop Relat Res."},{"issue":"8","key":"bib45-20230811","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1016\/j.injury.2007.09.017","article-title":"Lateral compression fracture of the pelvis represents a heterogeneous group of complex 3D patterns of displacement","volume":"39","author":"Khoury","year":"2008","journal-title":"Injury."},{"key":"bib46-20230811","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1097\/00003086-198904000-00009","article-title":"The role of external fixation in pelvic disruptions","volume":"241","author":"Kellam","year":"1989","journal-title":"Clin Orthop Relat Res."},{"issue":"7","key":"bib47-20230811","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.2106\/00004623-198264070-00007","article-title":"Unstable fractures of the pelvis treated by external fixation","volume":"64","author":"Wild","year":"1982","journal-title":"J Bone Joint Surg Am."},{"key":"bib48-20230811","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/00003086-199608000-00018","article-title":"Outcome of rotationally unstable pelvic ring injuries treated operatively","volume":"329","author":"Tornetta","year":"1996","journal-title":"Clin Orthop Relat Res."},{"issue":"5","key":"bib49-20230811","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1097\/BOT.0b013e31816b6b4e","article-title":"Minimum 1-year follow-up for patients with vertical shear sacroiliac joint dislocations treated with iliosacral screws: does joint ankylosis or anatomic reduction contribute to functional outcome?","volume":"22","author":"Mullis","year":"2008","journal-title":"J Orthop Trauma."},{"issue":"5","key":"bib50-20230811","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1080\/17453670510041754","article-title":"Outcome of operatively treated type-C injuries of the pelvic ring","volume":"76","author":"Lindahl","year":"2005","journal-title":"Acta Orthop."},{"issue":"3","key":"bib51-20230811","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1097\/00005131-199803000-00001","article-title":"Long-term functional prognosis of posterior injuries in high-energy pelvic disruption","volume":"12","author":"Dujardin","year":"1998","journal-title":"J Orthop Trauma."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201809050-00009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:25:53Z","timestamp":1787750753000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201809050-00009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,5]]},"references-count":51,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.17.01650","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,5]]}}}