The Nonoperative Management of Minimally Displaced Lateral Compression Type 1 (LC1) Pelvic Ring Injuries With and Without Occult Instability.

OBJECTIVES To determine the association of pelvic fracture displacement on lateral stress radiographs (LSR) with the hospital course of patients with minimally displaced lateral compression type 1 (LC1) pelvic injuries. DESIGN Retrospective review. SETTING Level one trauma centerPatients/Participants: 28 adult patients with minimally displaced (<1cm) LC1 injuries. INTERVENTION Nonoperative management. MAIN OUTCOME MEASUREMENTS Delayed operative fixation, days to clear physical therapy, mobilization, hospital length of stay (LOS), total hospital opioid morphine equivalent dose (MED). RESULTS LSR displacement was correlated with delayed operative fixation (r=0.23, 95% confidence interval (CI) 0.05 to 1.11; p=0.01), days to clear PT (r=0.13, CI 0.01 to 0.28; p=0.02), LOS (r=0.13, CI 0.006 to 0.26; p=0.02), and opioid MED (r=19.4, CI 1.5 to 38.1; p=0.03). A receiver operating characteristic curve for delayed operative fixation over LSR displacement had an area under the curve (AUC) of 0.87. The LSR displacement threshold that maximized sensitivity and specificity for detecting patients who required delayed fixation was 10 mm (100% sensitivity, 78% specificity). 10 of the 15 patients with ≥10 mm of displacement on LSR underwent delayed operative fixation for pain with mobilization at a median of 6 days (interquartile range 3.7 to 7.5). Patients with ≥10 mm of displacement on LSR took longer to clear PT, took longer to walk 15 feet, had longer hospital stays, and used more opioids. CONCLUSIONS LC1 fracture displacement on LSR is associated with delayed operative fixation, difficulty mobilizing secondary to pain, longer hospital stays, and opioid use. LEVEL OF EVIDENCE Diagnostic level III. See Instructions for Authors for a complete description of levels of evidence.