Universität zu Köln

Lehmann, Wolfgang, Hoffmann, Michael, Fensky, Florian ORCID: 0000-0002-8437-3247, Nuechtern, Jakob, Grossterlinden, Lars, Aghayev, Emin, Lehmann, Helmar ORCID: 0000-0001-6205-2293, Stuby, Fabian and Rueger, Johannes M. (2014). What Is the Frequency of Nerve Injuries Associated With Acetabular Fractures? Clin. Orthop. Rel. Res., 472 (11). S. 3395 - 3404. NEW YORK: SPRINGER. ISSN 1528-1132

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Abstract

Acetabular fractures and surgical interventions used to treat them can result in nerve injuries. To date, only small case studies have tried to explore the frequency of nerve injuries and their association with patient and treatment characteristics. High-quality data on the risk of traumatic and iatrogenic nerve lesions and their epidemiology in relation to different fracture types and surgical approaches are lacking. The purpose of this study was to determine (1) the proportion of patients who develop nerve injuries after acetabular fracture; (2) which fracture type(s) are associated with increased nerve injury risk; and (3) which surgical approach was associated with the highest proportion of patients developing nerve injuries using data from the German Pelvic Trauma Registry. Two secondary aims were (4) to assess hospital volume-nerve-injury relationship; and (5) internal data validity. Between March 2001 and June 2012, 2236 patients with acetabular fractures were entered into a prospectively maintained registry from 29 hospitals; of those, 2073 (92.7%) had complete records on the endpoints of interest in this retrospective study and were analyzed. The neurological status in these patients was captured at their admission and at the discharge. A total of 1395 of 2073 (67%) patients underwent surgery, and the proportions of intervention-related and other hospital-acquired nerve injuries were obtained. Overall proportions of patients developing nerve injuries, risk based on fracture type, and risk of surgical approach type were analyzed. The proportion of patients being diagnosed with nerve injuries at hospital admission was 4% (76 of 2073) and at discharge 7% (134 or 2073). Patients with fractures of the posterior wall (relative risk [RR], 2.0; 95% confidence interval [CI], 1.4-2.8; p = 0.001), posterior column and posterior wall (RR, 2.9; CI, 1.6-5.0; p = 0.002), and transverse + posterior wall fracture (RR, 2.1; CI, 1.3-3.5; p = 0.010) were more likely to have nerve injuries at hospital discharge. The proportion of patients with intervention-related nerve injuries and that of patients with other hospital-acquired nerve injuries was 2% (24 of 1395 and 46 of 2073, respectively). They both were associated with the Kocher-Langenbeck approach (RR, 3.0; CI, 1.4-6.2; p = 0.006; and RR, 2.4; CI, 1.4-4.3; p = 0.004, respectively). Acetabular fractures with the involvement of posterior wall were most commonly accompanied with nerve injuries. The data suggest also that Kocher-Langenbeck approach to the pelvic ring is associated with a higher risk of perioperative nerve injuries. Trauma surgeons should be aware of common nerve injuries, particularly in posterior wall fractures. The results of the study should help provide patients with more exact information on the risk of perioperative nerve injuries in acetabular fractures. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Lehmann, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoffmann, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Fensky, Florian UNSPECIFIED orcid.org/0000-0002-8437-3247 UNSPECIFIED Nuechtern, Jakob UNSPECIFIED UNSPECIFIED UNSPECIFIED Grossterlinden, Lars UNSPECIFIED UNSPECIFIED UNSPECIFIED Aghayev, Emin UNSPECIFIED UNSPECIFIED UNSPECIFIED Lehmann, Helmar UNSPECIFIED orcid.org/0000-0001-6205-2293 UNSPECIFIED Stuby, Fabian UNSPECIFIED UNSPECIFIED UNSPECIFIED Rueger, Johannes M. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-424951
DOI:	10.1007/s11999-014-3838-9
Journal or Publication Title:	Clin. Orthop. Rel. Res.
Volume:	472
Number:	11
Page Range:	S. 3395 - 3404
Date:	2014
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1528-1132
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language OBTURATOR NERVE; STOPPA APPROACH; ENTRAPMENT; FIXATION Multiple languages Orthopedics; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/42495