Attitudes of orthopedic trauma surgeons regarding current controversies inthe management of pelvic and acetabular fractures

A closed-ended questionnaire was mailed to all 363 active members of the Or thopaedic Trauma Association. It directed, toward practicing pelvic and ace tabular surgeons, questions pertaining to practice demographics and preferr ed methods for detection and prevention of deep venous thrombosis (,DVT), n erve injury, and heterotopic ossification (HO). Questionnaires were receive d from 226 surgeons (62 percent). Of the surgeons who responded, 181 (80 pe rcent) perform pelvic-fracture and acetabular-fracture surgery; only questi onnaires from this group were analyzed. Standard statistical methods were used to perform both univariate and multi variate analyses. Preoperative DVT screening was performed by 48 percent of the surgeons; ultrasound was the most commonly used modality (82 percent). Preoperative DVT prophylaxis was administered by 88 percent of those surve yed; the majority (78 percent) used sequential compression, devices. Postop erative prophylaxis was used by 99 percent; the most commonly used modality was sequential compression devices. Analysis suggests that fellowship-trai ned surgeons and surgeons in practice for fewer than twenty years are more likely to use preoperative DVT prophylaxis. HO prophylaxis was administered by 88 percent; the most commonly used modality was indomethacin. Intraoper ative nerve monitoring was performed by only 15 percent of the respondents. Most surgeons employed prophylactic measures to prevent DVT and HO. The wid e variation in type of prophylaxis and reasons for use suggests that contro versy will continue, and a standard of care for these conditions has yet to be defined. Very few surgeons use intraoperative nerve monitoring routinel y.