{"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":1791933186089,"version":"4.3.4"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,2,16]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Occult instability of lateral compression type-1 (LC1) pelvic ring injuries may be determined with a fluoroscopic stress examination under anesthesia (EUA) performed in the operating room. We hypothesized that LC1 injuries, similar to some fractures of the extremities, could be radiographically stressed for stability in the emergency department (ED). Our primary objective was to determine if stress examination of LC1 fractures could be safely and accurately performed in the ED and could be tolerated by patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A prospective, consecutive series of 70 patients with minimally displaced LC1 pelvic injuries (&lt;10-mm displacement on presentation) underwent stress examinations performed by the on-call orthopaedic resident in the ED radiology suite. The stress examination series included static 40\u00b0 inlet, internal rotation stress inlet, and external rotation stress inlet views. Pelvic fractures that had positive stress results (\u226510 mm of overlap of the rami) were indicated for a surgical procedure. These fractures also underwent EUA in order for the 2 techniques to be compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>All patients tolerated the ED stress examination without general anesthetic or hemodynamic instability. Fifty-seven patients (81%) had negative stress results and were allowed to bear weight. All patients with negative stress results who had 3-month follow-up went on to radiographic union without substantial displacement. For the patients with a positive stress result in the ED, the mean displacement was 15.15 mm (95% confidence interval [CI], 10.8 to 19.4 mm) for the ED stress test and 15.60 mm (95% CI, 11.7 to 19.4 mm) for the EUA (p = 0.86). Two patients with a negative ED stress test did not mobilize during their hospitalization and underwent EUA and conversion to a surgical procedure. Thus, a total of 11 patients underwent both stress testing in the ED and EUA; no patient had a positive result on one test but a negative result on the other.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>ED stress examination of LC1 injuries is a safe and reliable method to determine pelvic ring stability. The displacement measured in the ED stress examination is similar to the displacement measured under general anesthesia. Furthermore, a negative ED stress examination predicts successful nonoperative treatment. Given the results of this study, we encourage the use of stress examination in the ED for LC1-type injuries involving complete sacral fractures only. Widescale adoption of this streamlined protocol may substantially diminish cost, anesthetic risk, and potential operations for patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Diagnostic\n                      <jats:underline>Level II<\/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.21.00737","type":"journal-article","created":{"date-parts":[[2021,12,18]],"date-time":"2021-12-18T06:00:32Z","timestamp":1639807232000},"page":"336-344","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":32,"title":["Emergency Department Stress Radiographs of Lateral Compression Type-1 Pelvic Ring Injuries Are Safe, Effective, and Reliable"],"prefix":"10.2106","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9670-8211","authenticated-orcid":false,"given":"Graham J.","family":"DeKeyser","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5973-8013","authenticated-orcid":false,"given":"Patrick J.","family":"Kellam","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8269-3925","authenticated-orcid":false,"given":"Justin M.","family":"Haller","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4679-8583","authenticated-orcid":false,"given":"Thomas F.","family":"Higgins","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4499-6669","authenticated-orcid":false,"given":"Lucas S.","family":"Marchand","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7749-3662","authenticated-orcid":false,"given":"David L.","family":"Rothberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,12,17]]},"reference":[{"issue":"7","key":"bib1-20250430","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":"1","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1302\/0301-620X.70B1.3276697","article-title":"Pelvic ring fractures: should they be fixed?","volume":"70","author":"Tile","year":"1988","journal-title":"J Bone Joint Surg Br."},{"issue":"2","key":"bib3-20250430","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":"1","key":"bib4-20250430","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":"12","key":"bib5-20250430","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":"12","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1097\/BOT.0000000000001587","article-title":"Surgery for unilateral sacral fractures: are the indications clear?","volume":"33","author":"Vallier","year":"2019","journal-title":"J Orthop Trauma."},{"issue":"4","key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"157","DOI":"10.5435\/JAAOS-D-18-00821","article-title":"High-energy lateral compression type 1 injuries of the pelvis: a spectrum of injury","volume":"28","author":"Tejwani","year":"2020","journal-title":"J Am Acad Orthop Surg."},{"issue":"8","key":"bib8-20250430","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."},{"issue":"8","key":"bib9-20250430","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":"9","key":"bib10-20250430","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1097\/BOT.0b013e3181f8be33","article-title":"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":"1","key":"bib11-20250430","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":"9","key":"bib12-20250430","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":"9","key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"e304","DOI":"10.1097\/BOT.0000000000001759","article-title":"A survey to assess agreement between pelvic surgeons on the outcome of examination under anesthesia for lateral compression pelvic fractures","volume":"34","author":"Carney","year":"2020","journal-title":"J Orthop Trauma."},{"issue":"17","key":"bib14-20250430","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.2106\/JBJS.17.01650","article-title":"Fixation strategy using sequential intraoperative examination under anesthesia for unstable lateral compression pelvic ring injuries reliably predicts union with minimal displacement","volume":"100","author":"Avilucea","year":"2018","journal-title":"J Bone Joint Surg Am."},{"issue":"12","key":"bib15-20250430","doi-asserted-by":"crossref","first-page":"2553","DOI":"10.1007\/s00264-012-1685-4","article-title":"Assessment of lateral compression type 1 pelvic ring injuries by intraoperative manipulation: which fracture pattern is unstable?","volume":"36","author":"Tosounidis","year":"2012","journal-title":"Int Orthop."},{"issue":"10","key":"bib16-20250430","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.2106\/00004623-200410000-00007","article-title":"Stress examination of supination external rotation-type fibular fractures","volume":"86","author":"McConnell","year":"2004","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib17-20250430","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1007\/s11999-011-2008-6","article-title":"Can stress radiography of the knee help characterize posterolateral corner injury?","volume":"470","author":"Gwathmey","year":"2012","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib18-20250430","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1148\/radiology.191.1.8134574","article-title":"Stress radiography of the medial elbow ligaments","volume":"191","author":"Rijke","year":"1994","journal-title":"Radiology."},{"issue":"12","key":"bib19-20250430","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1097\/BOT.0000000000000130","article-title":"Nonoperative treatment of intermediate severity lateral compression type 1 pelvic ring injuries with minimally displaced complete sacral fracture","volume":"28","author":"Gaski","year":"2014","journal-title":"J Orthop Trauma."},{"issue":"10","key":"bib20-20250430","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1097\/BOT.0b013e318251217b","article-title":"Nonoperative immediate weightbearing of minimally displaced lateral compression sacral fractures does not result in displacement","volume":"26","author":"Sembler Soles","year":"2012","journal-title":"J Orthop Trauma."},{"issue":"10","key":"bib21-20250430","doi-asserted-by":"crossref","first-page":"2399","DOI":"10.1007\/s00264-018-4268-1","article-title":"Occult injuries of the contralateral sacroiliac joint in operatively treated pelvis fractures: incidence, root cause analysis, and proposal of treatment algorithm","volume":"43","author":"Maertens","year":"2019","journal-title":"Int Orthop."},{"issue":"1","key":"bib22-20250430","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1186\/s12891-021-04131-w","article-title":"Is the contralateral lesser trochanter a reliable reference for planning of total hip arthroplasty - a 3-dimensional analysis","volume":"22","author":"Hasler","year":"2021","journal-title":"BMC Musculoskelet Disord."},{"issue":"8","key":"bib23-20250430","doi-asserted-by":"crossref","first-page":"e289","DOI":"10.1097\/BOT.0000000000002026","article-title":"Validation of relative motion measurement method of lateral compression pelvic fractures during examination under anesthesia","volume":"35","author":"Jacobs","year":"2021","journal-title":"J Orthop Trauma."},{"issue":"3","key":"bib24-20250430","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1097\/BOT.0b013e31829efcc5","article-title":"Radiographic displacement in pelvic ring disruption: reliability of 3 previously described measurement techniques","volume":"28","author":"Lefaivre","year":"2014","journal-title":"J Orthop Trauma."},{"issue":"4","key":"bib25-20250430","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":"9","key":"bib26-20250430","doi-asserted-by":"crossref","first-page":"2178","DOI":"10.1097\/CORR.0000000000000861","article-title":"Classifications in brief: the Denis classification of sacral fractures","volume":"477","author":"Rizkalla","year":"2019","journal-title":"Clin Orthop Relat Res."},{"issue":"2","key":"bib27-20250430","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":"4","key":"bib28-20250430","first-page":"949","article-title":"The impact of open reduction internal fixation on acute pain management in unstable pelvic ring injuries","volume":"68","author":"Barei","year":"2010","journal-title":"J Trauma."},{"issue":"6","key":"bib29-20250430","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1007\/s11999-015-4525-1","article-title":"Does surgical stabilization of lateral compression-type pelvic ring fractures decrease patients\u2019 pain, reduce narcotic use, and improve mobilization?","volume":"474","author":"Hagen","year":"2016","journal-title":"Clin Orthop Relat Res."},{"issue":"11","key":"bib30-20250430","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1097\/BOT.0000000000001805","article-title":"The lateral stress radiograph identifies occult instability of lateral compression pelvic ring injuries without sedation","volume":"34","author":"Parry","year":"2020","journal-title":"J Orthop Trauma."},{"issue":"2","key":"bib31-20250430","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/BOT.0000000000001639","article-title":"Validated radiographic scoring system for lateral compression type 1 pelvis fractures","volume":"34","author":"Beckmann","year":"2020","journal-title":"J Orthop Trauma."},{"issue":"2","key":"bib32-20250430","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.injury.2014.10.050","article-title":"Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring fractures","volume":"46","author":"N\u00fcchtern","year":"2015","journal-title":"Injury."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.21.00737","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:47:15Z","timestamp":1787752035000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.21.00737"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,17]]},"references-count":32,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.21.00737","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,17]]}}}