Patients with combined pelvic and cranio-cerebral-injuries have worse clinical and operative outcomes than patients with isolated pelvic injuries. Analysis of the German Pelvic Registry
Authors: Navas Luis , Mengis Natalie , Gühring Thorsten , Zimmerer Alexander , Girnstein Carolina , Höch Andreas , Histing Tina , Herath Steven , Küper Markus , Schneider Marco , Ulmar Benjamin 
Published: May 2023

Abstract
Background
Pelvic fractures are often combined with craniocerebral injuries in polytrauma patients. This study aimed to assess the impact of concomitant cranio-cerebral injuries on the clinical and surgical outcomes of pelvic fractures.
Methods
Retrospective data analysis was conducted on patients registered in the German Pelvic Registry between January 2003 and December 2017. Patients were categorized into groups based on the presence of isolated pelvic fractures (group A), pelvic fractures with cranio-cerebral injuries (group B), isolated acetabular fractures (group C), and acetabular fractures with cranio-cerebral injuries (group D). Surgical parameters, clinical characteristics, and outcomes were compared among the groups.
Results
Group B exhibited a significantly higher frequency of general surgical procedures and emergency pelvic stabilizations for pelvic injuries compared to Group A (58.4% vs. 35.4% and 31% vs. 2.8%; p < 0.0001 for both). The time until emergency stabilization was shorter in Group B than in Group A (111 ± 87 vs. 153 ± 95 min; p = 0.58). However, the mean time for definitive stabilization of the pelvic fracture was longer in Group B than in Group A (5.3 ± 8.3 vs. 3.7 ± 6.4 days; p = 0.0341). Group B had significantly higher mean duration of treatment, mortality, and morbidity compared to Group A (p < 0.0001 for both mortality and treatment duration, p = 0.0325 for morbidity). In the comparison of acetabular fractures, Group D had a slightly lower incidence of preoperative fracture-dislocation but a slightly higher incidence of postoperative fracture-dislocation compared to Group C. The distribution of Matta grades differed significantly between the two groups. Preoperative fracture step-off was significantly lower in Group D than in Group C (7.24 vs. 7.33 mm, p = 0.025). However, there was no significant difference in postoperative fracture step-off between Groups C and D (1.86 vs. 1.77 mm, p = 0.31).
Conclusion
The delay in providing definitive surgical treatment for pelvic injuries in the presence of accompanying cranio-cerebral injuries has a negative impact on the clinical and surgical outcomes of pelvic and acetabular fractures, particularly in terms of reduced quality of acetabular fractures. Severe associated injuries such as cranio-cerebral injuries contribute to higher morbidity, long-term disability, mortality, and extended hospital stays. To enhance overall and long-term outcomes for these patients, it is essential to engage in interdisciplinary consultations. By fostering collaboration among different medical specialties, the management and treatment of these complex cases can be optimized, leading to improved patient outcomes and quality of care.
Study design Retrospective cohort study, level of evidence III