Research ExplorerPublicationsWhat is the frequency of nerve injuries associated with acet...

What is the frequency of nerve injuries associated with acetabular fractures?

Standard

What is the frequency of nerve injuries associated with acetabular fractures? / Lehmann, Wolfgang; Hoffmann, Michael; Fensky, Florian; Nüchtern, Jakob; Großterlinden, Lars; Aghayev, Emin; Lehmann, Helmar; Stuby, Fabian; Rueger, Johannes M.

In: CLIN ORTHOP RELAT R, Vol. 472, No. 11, 01.11.2014, p. 3395-3403.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Lehmann, W, Hoffmann, M, Fensky, F, Nüchtern, J, Großterlinden, L, Aghayev, E, Lehmann, H, Stuby, F & Rueger, JM 2014, 'What is the frequency of nerve injuries associated with acetabular fractures?', CLIN ORTHOP RELAT R, vol. 472, no. 11, pp. 3395-3403. https://doi.org/10.1007/s11999-014-3838-9

APA

Lehmann, W., Hoffmann, M., Fensky, F., Nüchtern, J., Großterlinden, L., Aghayev, E., Lehmann, H., Stuby, F., & Rueger, J. M. (2014). What is the frequency of nerve injuries associated with acetabular fractures? CLIN ORTHOP RELAT R, 472(11), 3395-3403. https://doi.org/10.1007/s11999-014-3838-9

Vancouver

Lehmann W, Hoffmann M, Fensky F, Nüchtern J, Großterlinden L, Aghayev E et al. What is the frequency of nerve injuries associated with acetabular fractures? CLIN ORTHOP RELAT R. 2014 Nov 1;472(11):3395-3403. https://doi.org/10.1007/s11999-014-3838-9

Bibtex

@article{55e857435e3c438fb32e11c18a087093,
title = "What is the frequency of nerve injuries associated with acetabular fractures?",
abstract = "BACKGROUND: 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.QUESTIONS/PURPOSES: 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.METHODS: 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.RESULTS: 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).CONCLUSIONS: 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 OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.",
keywords = "Acetabulum, Comorbidity, Confidence Intervals, Evidence-Based Medicine, Female, Fracture Fixation, Internal, Fractures, Bone, Germany, Humans, Incidence, Male, Middle Aged, Peripheral Nerve Injuries, Prevalence, Registries, Retrospective Studies, Risk Assessment",
author = "Wolfgang Lehmann and Michael Hoffmann and Florian Fensky and Jakob N{\"u}chtern and Lars Gro{\ss}terlinden and Emin Aghayev and Helmar Lehmann and Fabian Stuby and Rueger, {Johannes M}",
year = "2014",
month = nov,
day = "1",
doi = "10.1007/s11999-014-3838-9",
language = "English",
volume = "472",
pages = "3395--3403",
journal = "CLIN ORTHOP RELAT R",
issn = "0009-921X",
publisher = "Springer New York",
number = "11",

}

RIS

TY - JOUR

T1 - What is the frequency of nerve injuries associated with acetabular fractures?

AU - Lehmann, Wolfgang

AU - Hoffmann, Michael

AU - Fensky, Florian

AU - Nüchtern, Jakob

AU - Großterlinden, Lars

AU - Aghayev, Emin

AU - Lehmann, Helmar

AU - Stuby, Fabian

AU - Rueger, Johannes M

PY - 2014/11/1

Y1 - 2014/11/1

N2 - BACKGROUND: 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.QUESTIONS/PURPOSES: 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.METHODS: 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.RESULTS: 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).CONCLUSIONS: 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 OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

AB - BACKGROUND: 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.QUESTIONS/PURPOSES: 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.METHODS: 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.RESULTS: 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).CONCLUSIONS: 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 OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

KW - Acetabulum

KW - Comorbidity

KW - Confidence Intervals

KW - Evidence-Based Medicine

KW - Female

KW - Fracture Fixation, Internal

KW - Fractures, Bone

KW - Germany

KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Peripheral Nerve Injuries

KW - Prevalence

KW - Registries

KW - Retrospective Studies

KW - Risk Assessment

U2 - 10.1007/s11999-014-3838-9

DO - 10.1007/s11999-014-3838-9

M3 - SCORING: Journal article

C2 - 25141842

VL - 472

SP - 3395

EP - 3403

JO - CLIN ORTHOP RELAT R

JF - CLIN ORTHOP RELAT R

SN - 0009-921X

IS - 11

ER -