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Purpose <p>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.</p> Methods <p>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.</p> Results <p>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%.</p> Conclusion <p>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.</p>

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

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  • 发表日期：

    2026年5月30日

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  • Camryn C. Therrien,
  • Kaj ten Duis,
  • Alessandro Aprato,
  • Hester Banierink,
  • Johannes D. Bastian,
  • Andreas Höch,
  • Umberto M. R. Mezzadri,
  • Jakob van Oldenrijk,
  • Philipp Pieroh,
  • Henry C. Sagi,
  • Jean-Paul P. M. de Vries,
  • Inge H. F. Reininga,
  • Frank F. A. IJpma,
  • Kamarul Arifin Abdul Razak,
  • Francesco Addevico,
  • Yaqoub Alotheri,
  • José Vicente Andrés-Peiró,
  • Charlotte Arand,
  • Ahmad Arieff Atan,
  • Mark C. P. M. van Baal,
  • Sebastiano Barreca,
  • Johannes Dominik Bastian,
  • Peter Bates,
  • Taco Bijlsma,
  • Eftychios Bolierakis,
  • Juan Boluda-Mengod,
  • Mehdi Boudissa,
  • Federico Bove,
  • Jeroen Bransen,
  • Pauline Buteau,
  • Alessandro Casiraghi,
  • Stefano Cattaneo,
  • Federico Chiodini,
  • Ferdinand Christian Wagner,
  • Carlo Colonna,
  • Andrej Cretnik,
  • Pietro De Biase,
  • Kaj ten Duis,
  • Michael J. R. Edwards,
  • Daphne van Embden,
  • Benjamin Erdle,
  • Jochen Franke,
  • Abramo Fratus,
  • Paul Kong Fu-Xiang,
  • Axel Gamulin,
  • Axel Gänsslen,
  • Leo M. G. Geeraedts Jr,
  • Antonio Gilli,
  • Miguel Ángel Giráldez-Sánchez,
  • Tjebbe Hagenaars,
  • Maximilian Hartel,
  • Svenhjalmar van Helden,
  • Steven C. Herath,
  • Erik Hermans,
  • Michiel Herteleer,
  • Nico Hinz,
  • Andreas Höch,
  • Mike Hogervorst,
  • Klemens Horst,
  • Aitor Ibarzábal-Gil,
  • Frank F. A. IJpma,
  • Eduardo Jose Burgos,
  • Muhammad Ade Junaidi,
  • Nikolaos Kanakaris,
  • Christian Kleber,
  • Wolfgang Lehmann,
  • Björn-Christian Link,
  • Emmanouil Liodakis,
  • Dario Lo Re,
  • Jean G. Louka,
  • Lapo De Luca,
  • Jan Erik Madsen,
  • Sven Märdian,
  • Arduini Mario,
  • Giovanni Materazzi,
  • Alberto Maurizio,
  • Jan Peter van Meirhaeghe,
  • Sven A. Meylaerts,
  • Umberto M. R. Mezzadri,
  • Ben Molenaers,
  • Antonio Moretti,
  • Jevgenijs Movcans,
  • Josep M. Muñoz-Vives,
  • Muhammad Yasir Bin Ahmad Muslim,
  • Robert J. Nijveldt,
  • Dmitry Notov,
  • Jakob van Oldenrijk,
  • Beatriz Olías-López,
  • Georg Osterhoff,
  • Salvatore Pantè,
  • Raffaele Pascarella,
  • Roman Pfeifer,
  • Philipp Pieroh,
  • Raúl G. Plomp,
  • Tim Pohlemann,
  • Nicolas Poinot,
  • Kees Jan Ponsen,
  • Guy Putzeys,
  • Victor A. De Ridder,
  • Pol M. Rommens,
  • Pieter-Jan De Roo,
  • Marco Santavicca,
  • Emmanuele Santolini,
  • Inger B. Schipper,
  • Uwe Schweigkofler,
  • Michal Stibor,
  • Sander F. L. van Stigt,
  • Vincent Stirler,
  • Charles Tatiana,
  • Jordi Teixidor-Serra,
  • Michel Paul Johan Teuben,
  • Andreas Thannheimer,
  • Frandin Thomas,
  • Andres Torrejón,
  • Viju Daniel Varghese,
  • Jan Verbruggen,
  • Luigi Branca Vergano,
  • Fabricio Videla,
  • Bas van Wageningen,
  • Daniel Wagner,
  • Peer van der Zwaal

摘要

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.