Examination under anesthesia imaging changes surgeons’ classification and treatment decisions of anterior posterior compression pelvic ring injuries

PURPOSE: To report on the effect that Pelvic Examination Under Anesthetic (EUA) has on modifying both the classification and treatment plan for Tile-B, Anterior Posterior Compression (APC) injuries. METHODS: Four hundred international pelvic surgeons were invited to participate in a two-part online survey. Each of the two surveys included the same ten cases selected to represent a spectrum of APC injuries, with the first survey containing only pre-operative static radiographic and CT imaging, and the second survey including the additional EUA images. Surgeons were asked to answer questions regarding classification and treatment. RESULTS: One hundred twenty-three pelvic surgeons participated (response rate = 31%). Respondents were primarily trauma surgeons (76%) from level 1 trauma centers (82%), with an average of ten (IQR 5-15) years of experience in treating pelvic injuries. The addition of EUA imaging resulted in 46% of the respondents in a change in classification, primarily shifting from APC1 (26% with static imaging to 17% with EUA imaging) to APC2 (57% to 67%). Treatment decisions changed in 36% of responses: non-operative management decreased from 15% to 7%, and anterior-only fixation increased from 22% to 35%. CONCLUSION: The addition of EUA images in external rotation pelvic ring injuries altered almost half of the surgeons' perceptions of the classification (46%) and-more importantly-over one-third (36%) of the surgeons' treatment plans. The addition of the EUA imaging had its most significant impact on revising injuries initially classified as APC1, indicating an underestimation of injury severity in this group. However, these changes varied widely across the representative injuries, with EUA serving as a confirmatory tool in some cases, while revealing occult instability in others.

Authors

Institutions

Publication Details

Journal
European Journal of Orthopaedic Surgery & Traumatology
Published
2026-05-30
DOI
https://doi.org/10.1007/s00590-026-04744-8
Primary Topic
Pelvic and Acetabular Injuries
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Examination under anesthesia imaging changes surgeons’ classification and treatment decisions of anterior posterior compression pelvic ring injuries

Charlotte Arand, Michael JR Edwards, Maximilian Härtel, Raffaele Pascarella et al.
European Journal of Orthopaedic Surgery & Traumatology
Pelvic and Acetabular Injuries
article

Examination under anesthesia imaging changes surgeons’ classification and treatment decisions of anterior posterior compression pelvic ring injuries

Charlotte Arand, Michael JR Edwards, Maximilian Härtel, Raffaele Pascarella, Andreas Höch, Dario Lo Re, Mark C. P. M. van Baal, Johannes Bastian, Pietro De Biase, Aitor Ibarzábal-Gil, Ferdinand Christian Wagner, Abramo Fratus, Mehdi Boudissa, Victor A. de Ridder, Georg Osterhoff, Sebastiano Barreca, Eftychios Bolierakis, Tim Pohlemann, Robert J. Nijveldt, Kamarul Arifin Abdul Razak, A Gilli, Nico Hinz, Kaj ten Duis, Ben Molenaers, Juan Boluda-Mengod, Tjebbe Hagenaars, Michiel Herteleer, Hester Banierink, Jan Erik Madsen, Muhammad Ade Junaidi, Axel Gänsslen, Jakob van Oldenrijk, Benjamin Erdle, Stefano Cattaneo, Federico Bove, Emmanouil Liodakis, Jeroen Bransen, Jan Van Meirhaeghe, Johannes Dominik Bastian, Eduardo José Burgos, Salvatore Pantè, Francesco Addevico, Sven H. van Helden, Federico Chiodini, Pauline Buteau, Jevgenijs Movcans, Dmitry Notov, Andrej Čretnik, Björn‐Christian Link, Leo M. G. Geeraedts, Alessandro Casiraghi, Beatriz Olías-López, Alessandro Aprato, Inge H. F. Reininga, Camryn C. Therrien, Wolfgang Lehmann, Mike Hogervorst, Lapo De Luca, Giovanni Materazzi, Kees Jan Ponsen, Raul G Plomp, Carlo Colonna, Taco Bijlsma, Nikolaos Kanakaris, Guy Putzeys, Frank F. A. IJpma, Henry C. Sagi, Jochen Franke, Antonio Moretti, Josep M. Muñoz-Vives, Miguel Ángel Giráldez-Sánchez, Daphne van Embden, Muhammad Yasir Bin Ahmad Muslim, José Vicente Andrés-Peiró, Sven A. Meylaerts, Arduini Mario, Jean G. Louka, Philipp Pieroh, Klemens Horst, Roman Pfeifer, Christian Kleber, Umberto M. R. Mezzadri, Ahmad Arieff Atan, Society of European Pelvic and Acetabulum Surgeons, Jean-Paul P. M. de Vries, Alberto Maurizio, Sven Märdian, Yaqoub Alotheri, Paul Kong Fu-Xiang, Peter Bates, Steven C. Herath, Nicolas Poinot, Axel Gamulin, Erik Hermans
article en

Abstract

PURPOSE: To report on the effect that Pelvic Examination Under Anesthetic (EUA) has on modifying both the classification and treatment plan for Tile-B, Anterior Posterior Compression (APC) injuries. METHODS: Four hundred international pelvic surgeons were invited to participate in a two-part online survey. Each of the two surveys included the same ten cases selected to represent a spectrum of APC injuries, with the first survey containing only pre-operative static radiographic and CT imaging, and the second survey including the additional EUA images. Surgeons were asked to answer questions regarding classification and treatment. RESULTS: One hundred twenty-three pelvic surgeons participated (response rate = 31%). Respondents were primarily trauma surgeons (76%) from level 1 trauma centers (82%), with an average of ten (IQR 5-15) years of experience in treating pelvic injuries. The addition of EUA imaging resulted in 46% of the respondents in a change in classification, primarily shifting from APC1 (26% with static imaging to 17% with EUA imaging) to APC2 (57% to 67%). Treatment decisions changed in 36% of responses: non-operative management decreased from 15% to 7%, and anterior-only fixation increased from 22% to 35%. CONCLUSION: The addition of EUA images in external rotation pelvic ring injuries altered almost half of the surgeons' perceptions of the classification (46%) and-more importantly-over one-third (36%) of the surgeons' treatment plans. The addition of the EUA imaging had its most significant impact on revising injuries initially classified as APC1, indicating an underestimation of injury severity in this group. However, these changes varied widely across the representative injuries, with EUA serving as a confirmatory tool in some cases, while revealing occult instability in others.

European Journal of Orthopaedic Surgery & TraumatologyVol. 36(1)
University Medical Center Groningen (NL), University of Groningen (NL), University Hospital of Bern (CH), Erasmus MC (NL), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), University Hospital Leipzig (DE), Cincinnati Sportsmedicine and Orthopaedic Center (US), Department of Medical Sciences (BY), University of Turin (IT), University of Cincinnati (US), Erasmus University Rotterdam (NL), University of Cincinnati Medical Center (US)
Good health and well-being
Openalex Percentile: Top 4%
Pelvic and Acetabular Injuries
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.