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The Development of a Universally Accepted Sacral Fracture Classification: A Survey of AOSpine and AOTrauma Members.

ABSTRACT: Study Design?Survey study. Objective?To determine the global perspective on controversial aspects of sacral fracture classifications. Methods?While developing the AOSpine Sacral Injury Classification System, a survey was sent to all members of AOSpine and AOTrauma. The survey asked four yes-or-no questions to help determine the best way to handle controversial aspects of sacral fractures in future classifications. Chi-square tests were initially used to compare surgeons' answers to the four key questions of the survey, and then the data was modeled through multivariable logistic regression analysis. Results?A total of 474 surgeons answered all questions in the survey. Overall 86.9% of respondents felt that the proposed hierarchical nature of injuries was appropriate, and 77.8% of respondents agreed that that the risk of neurologic injury is highest in a vertical fracture through the foramen. Almost 80% of respondents felt that the separation of injuries based on the integrity of L5-S1 facet was appropriate, and 83.8% of surgeons agreed that a nondisplaced sacral U fracture is a clinically relevant entity. Conclusion?This study determines the global perspective on controversial areas in the injury patterns of sacral fractures and demonstrates that the development of a comprehensive and universally accepted sacral classification is possible.

SUBMITTER: Schroeder GD

PROVIDER: S-EPMC5077717 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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The Development of a Universally Accepted Sacral Fracture Classification: A Survey of AOSpine and AOTrauma Members.

Schroeder Gregory D GD Kurd Mark F MF Kepler Christopher K CK Krieg James C JC Wilson Jefferson R JR Kleweno Conor P CP Firoozabadi Reza R Bellabarba Carlo C Kandizoria Frank F Schnake Klause J KJ Rajesekaran S S Dvorak Marcel F MF Chapman Jens R JR Vialle Luiz R LR Oner F C FC Vaccaro Alexander R AR

Global spine journal 20160317 7

Study Design Survey study. Objective To determine the global perspective on controversial aspects of sacral fracture classifications. Methods While developing the AOSpine Sacral Injury Classification System, a survey was sent to all members of AOSpine and AOTrauma. The survey asked four yes-or-no questions to help determine the best way to handle controversial aspects of sacral fractures in future classifications. Chi-square tests were initially used to compare surgeons' ans ...[more]

PMID: 27781189

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Project description:When immigrant minority individuals engage in frequent and positive social contact with majority culture members, their emotions become a better fit with the majority norm; the increased fit is called emotional acculturation. In the current research, we test the prediction that high-quality interactions with majority others, in which minorities feel accepted, increase the likelihood of emotional fit. We also explore whether this prediction holds true for both positive and negative interactions with majority. To test this prediction, we conducted a 7-day daily diary study with minority students in Belgian middle schools (N = 117). Each day, participants reported one positive and one negative interaction at school. They subsequently evaluated each interaction (e.g., felt accepted), assessed their relationship with the interaction partner (e.g., our relationship is important to me), and rated their emotions. Analyses focused on the interactions with Belgian majority interaction partners. Emotional acculturation was computed for positive and negative interactions separately, by calculating the fit between the emotional pattern of the minority student and the average emotional pattern of a sample of majority participants (N = 106) who also took part in the daily diary. As predicted, we found higher emotional fit in positive interactions when immigrant minorities felt accepted by the interaction partner. In contrast to this finding for positive interactions, emotional fit for negative interactions was higher when minorities felt excluded by the interaction partner. Further analyses on the negative interactions suggested that minority adolescents felt more negative autonomy-promoting emotions (e.g., anger and frustration) when they perceived being excluded. Given that Belgian majority youth feel more autonomy-promoting emotions generally, minorities' fit with majority patterns was higher. The results confirm our hypothesis that minorities' fit with majority emotions is contingent on the quality of their interactions with majority, even if in negative interactions, high-quality interactions produced less rather than more emotional fit. Our findings suggest that emotional acculturation is not just a 'skill' that minority individuals acquire, but also a response to the ways in which interactions with majority others develop. Inclusive interactions, especially when they are positive, appear to align immigrant minority individuals with the majority norm.

Project description:ObjectiveTo determine the feasibility of designing and conducting a definitive trial to evaluate the effectiveness of sacral fracture fixation compared with non-surgical management among older people admitted with a lateral compression pelvic fragility fracture (PFF).DesignSingle-site, parallel, two-arm randomised controlled feasibility trial.SettingA UK tertiary centre hospital.ParticipantsPatients aged ≥70 years who were ambulating pre-injury requiring hospital admission (within 28 days of injury) with a type 1 lateral compression PFF.InterventionsThe intervention group received sacral fracture fixation (cement augmentation±screw fixation) within 7 days of randomisation. Routine preoperative and postoperative care followed each surgical intervention. The control group received usual care consisting of analgesia, and regular input from the medical and therapy team.Primary and secondary outcome measuresThe feasibility outcomes were the number of eligible patients, willingness to be randomised, adherence to allocated treatment, retention, data on the completeness and variability of the proposed definitive trial outcome measures, and reported adverse events.Results241 patients were screened. 13 (5.4%) were deemed eligible to participate. Among the eligible participants, nine (69.2%) were willing to participate. Five participants were randomised to the intervention group and four to the control group. The clinicians involved were willing to allow their patients to be randomised and adhere to the allocated treatment. One participant in the intervention group and two participants in the control group received their allocated treatment. All participants were followed up until 12 weeks post-randomisation, and had an additional safety follow-up assessment at 12 months. Overall, the proportion of completeness of outcome measures was at least 75%. No adverse events were directly related to the trial.ConclusionsThere were significant challenges in recruiting sufficient participants which will need to be addressed prior to a definitive trial.Trial registration numberISRCTN16719542.

Project description:IntroductionPelvic fragility fractures (PFF) are common in older people and associated with a significant burden of mortality and morbidity. This is related to the challenges of appropriate pain control and early mobilisation. The current standard for treatment of PFF is non-surgical management. Minimally invasive surgical techniques for sacral fracture stabilisation have been shown to improve outcomes in terms of pain control and mobility, and they are safe. Randomised controlled trials are required before recommendations can be made for surgical management of PFF to become the new standard of care. This feasibility study will explore several uncertainties around conducting such a trial.Methods and analysisASSERT (Acute Sacral inSufficiEncy fractuRe augmenTation) is a single-site randomised controlled, parallel-arm, feasibility trial of surgical stabilisation versus non-surgical management of acute sacral fragility fractures in people aged 70 years and over. Patients will be randomised to either surgical or non-surgical group on a 1:1 ratio. Follow-up of participants will occur at 2, 4 and 12 weeks with safety data collected at 52 weeks. Primary objectives are to determine feasibility and design of a future trial, including outcomes on recruitment, adherence to randomisation and safety. This will be supplemented with a qualitative interview study of participants and clinicians. Secondary objectives will inform study design procedures to determine clinical and economic outcomes between groups, including scored questionnaires, analgesia requirements, resource use and quality of life data. Data analysis will be largely descriptive to inform outcomes and future sample size.Ethics and disseminationEthical approval was granted by the North East Newcastle and North Tyneside 2 Research Ethics Committee (reference 18/NE/0212). ASSERT was approved and sponsored by Nottingham University Hospitals NHS Trust (reference 18HC001) and the Health Research Authority (reference IRAS 232791). Recruitment is ongoing. Results will be presented at relevant conferences and submitted to appropriate journals on study completion.Trial registration numberISRCTN16719542; Pre-results.

Dataset Information

The Development of a Universally Accepted Sacral Fracture Classification: A Survey of AOSpine and AOTrauma Members.

Publications

The Development of a Universally Accepted Sacral Fracture Classification: A Survey of AOSpine and AOTrauma Members.

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