Risk factors of pelvic fracture combined with humeral fracture: A retrospective study

Risk factors of pelvic fracture combined with humeral fracture: A retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk factors of pelvic fracture combined with humeral fracture: A retrospective study Zhengjiang Li, Xing Chen, Yan Zhang, Shunqiang Li, Haibo Ji, Yongkui Li, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1604358/v2 This work is licensed under a CC BY 4.0 License Status: Posted Version 2 posted You are reading this latest preprint version Show more versions Abstract Background Pelvic fractures are often associated with other injuries, and in our study, pelvic fractures associated with humeral fractures were the most common. We pooled patient data to analyze the independent risk factors for pelvic fractures associated with humeral fractures. Methods A retrospective study was conducted on the clinical data of 254 patients with pelvic fractures admitted to the Department of Orthopedics of Chengdu Fifth People’s Hospital, from August 2017 to August 2021. Independent sample T test found that pelvic fractures combined with humeral fractures were statistically significant. The main outcome indicators of pelvic fracture combined with humeral fracture were as follows: Tile classification of pelvic fractures, number of humeral fractures and Injury Severity Scale (ISS); Secondary outcome indicators: gender, age, body mass index (BMI), cause of injury, underlying diseases, etc. Single factor analysis was performed to screen risk factors for each indicator, and logistic analysis was used to determine independent risk factors for indicators with P < 0.05. Results Of the 254 patients with pelvic fractures, 24 (9.45%) were associated with humeral fractures, much higher than other single injuries, and only pelvic fractures associated with humeral fractures were statistically significant ( P = 0.014). Pelvic fractures without concomitant humeral fractures (n = 230) and pelvic fractures with concomitant humeral fractures (n = 24) were associated with age ( P = 0.006; 95% CI = 0.087–0.665; OR = 10.258), ISS score ( P = 0.002; 95% CI = 1.839–4.445; OR = 8.721), Tile scores ( P = 0.01; 95% CI = 22.554–87.419; OR = 22.736), but there was no statistical significance in gender ( P = 1.03), BMI ( P = 0.437) and injury cause ( P = 3.04). Conclusion The combination of pelvic fracture and humerus fracture was statistically significant, and age > 60 years old, pelvic fracture Tile B2 classification above and high ISS were the independent risk factors for humerus fracture in pelvic fracture. Therefore, in clinical work, when clinicians treat patients with pelvic fractures aged > 60 years old, Tile B2 type above classification of pelvic fractures and high ISS, they should be highly vigilant about whether the humerus fractures are accompanied. Pelvic fracture Humeral fracture Risk factors Age Injury severity score Tile type Figures Figure 1 Background Pelvic fractures are mostly caused by high energy injuries, such as falling from a height or car collision caused by fractures, pelvic fractures accounted for 2.8%. In addition, 20% of multiple trauma patients with blunt trauma also had pelvic injury[ 1 ]. Of all musculoskeletal injuries, pelvic fractures are considered to be the leading cause of death and morbidity. According to statistics, the incidence of pelvic fracture accounted for 1%~3% of the total number of systemic fractures, its disability rate was 50%~60%, and its fatality rate was as high as 10%~25%[ 2 , 3 ]. The mortality associated with open unstable pelvic fractures is approximately 20%, while the mortality associated with open fractures alone is approximately 50%. The incidence of pelvic fractures is reported to be 17–37/100,000 persons/year, and the incidence of high-energy pelvic fractures is reported to be 10/100,000 persons/year. High energy pelvic fractures have traditionally been considered serious injuries, leading to a mortality rate of 47% in patients with multiple trauma[ 4 ]. In Rothenberg et al. 's study of 31 open pelvic injuries, the reported mortality was 42%[ 5 ]. Because the patient of pelvic fracture is often traumatized by great violence, often the serious trauma of other organization and organ is combined, the incidence rate of shock is as high as 30% above. However, once hemodynamic instability occurs after injury, it can significantly increase the mortality of patients. Death rates in patients reporting shock, such as Starr, can be as high as 57%[ 6 ]. However, for non-severe pelvic fractures, clinicians tend to pay attention to the complications related to pelvic fractures in addition to the fracture itself, which is easy to cause serious consequences and affect the subsequent diagnosis and treatment [ 7 ].Therefore, considering the high energy forces of pelvic injury, it is crucial to anticipate other related injuries in different body parts and systems. In addition, the assessment of patients with traumatic pelvic injury should not be taken lightly and the injury should not always be treated as an isolated case. Up to 60% of patients with pelvic injuries have long bone fractures, spinal fractures, head injuries, abdominal organ injuries or nervous system injuries[ 1 , 5 , 8 , 9 ]. Proximal humeral fractures are common, accounting for 4.6% of all fractures. They are mostly related to osteoporosis, with 78% of fractures occurring in older patients over the age of 65[ 10 , 11 ]. When a pelvic fracture is associated with a humerus fracture, the pain of the humerus fracture may not be obvious because the patient is bedridden and has little movement of the upper limb. Therefore, when pelvic fracture combined with humeral fracture, orthopedic surgeons and patients tend to pay more attention to the pelvis and easily ignore the humerus, resulting in missed diagnosis and delayed treatment, resulting in serious consequences. To clarify the clinical characteristics and risk factors of patients with pelvic fracture combined with humeral fracture is of great clinical significance for early detection and timely treatment of humeral fracture. Therefore, this study aims to retrospectively study the patients with pelvic fracture admitted to our department in recent 3 years, analyze the risk factors of pelvic fracture combined with humerus fracture, and provide evidence-based medical evidence for clinicians to be vigilant of combined humerus fracture when treating patients with pelvic fracture. Materials And Methods Patients In this retrospective study, we collected 254 patients with pelvic fractures who were treated at Department of Orthopedic Surgery, Chengdu Fifth People’s Hospital from August 2017 to August 2021. This study has been approved by the Medical Ethics Committee of Chengdu Fifth People’s Hospital, and all patients were informed of the risks and benefits of the trial, gave their consent and signed an informed consent. The outcome indicators were measured on the Neusoft PACS. Inclusion criteria: ① Pelvic fractures with a clear history of trauma; ② Complete clinical and imaging materials (X - ray and 3D-CT). Exclusion criteria: ① Pathological fracture; ② Old pelvic fracture or old humeral fracture; ③ Pelvic fracture and humeral fracture are not the same injury; ④ The accuracy of the results is affected by factors such as inability to judge or incomplete data. Data collection Data were collected by two independent investigators, including general baseline information (gender, age, body mass index (BMI), cause of injury, and underlying disease), imaging data (pelvic X-ray and 3D-CT, humeral X-ray and 3D-CT), and injury severity score (ISS). The pelvic fractures were Tile typed and recorded by two independent, senior physicians based on the patient's radiographic data and counted by a third independent investigator (Fig. 1 ). In the event of inconsistent results, the decision will be made jointly by the three independent investigators. Main outcome measures: Tile classification of pelvic fractures, number of humeral fractures, and ISS. Secondary outcome measures: gender, age, BMI, cause of injury, underlying diseases, etc. Statistical analysis Gender, age, BMI, ISS, cause of injury and Tile classification of pelvic fracture were used as independent variables, and pelvic fracture combined with humeral fracture was used as dependent variables (Fig. 1 ). See Table 1 for the assignment of variables. The independent T test was first used for univariate analysis (Table 3), and then the screened variables with P < 0.05 were analyzed by logistic analysis to determine risk factors. P < 0.05 was considered to be statistically significant. SPSS 23.0 (IBM Corp., USA) software was used for statistical analysis. Results Correlation analysis of pelvic fracture with humeral fracture A total of 254 patients were included in this study, including 133 males, accounting for 52.36%; 121 cases were female (47.64%). The age range was 10–91 years, with an average of 50.6 years. Among the injury causes, 115 cases were car accident injury, 79 cases were fall injury, 48 cases were high fall injury, 12 cases were crush injury. There were 143 cases with BMI > 25Kg/m 2 and 111 cases with BMI < 25Kg/m 2 . Tile classification of pelvic fractures: 116 cases of type A, 85 cases of type B and 53 cases of type C (Table. 3). There were 24 patients with pelvic fracture combined with humeral fracture, accounting for 9.45% of all combined injuries, far higher than other patients with single combined injuries, and only pelvic fracture combined with humeral fracture had statistical significance ( P = 0.014) (Table. 2), indicating the correlation between pelvic fracture combined with humeral fracture. Age ( P = 0.01), fracture Tile classification ( P = 0.02), ISS score ( P < 0.01), but there was no statistical significance in gender ( P = 1.03), BMI ( P = 0.437) and injury cause ( P = 3.04) (Table 3). It is suggested that age, fracture Tile classification and ISS are the risk factors of pelvic fracture combined with humerus fracture, while gender, BMI and injury cause have little influence on the incidence of pelvic fracture combined with humerus fracture. Logistic analysis of risk factors for pelvic fracture associated with humeral fracture In logistic analysis of pelvic fracture combined with humerus fracture, age, ISS and fracture Tile classification score were taken as independent variables, and pelvic fracture combined with humerus fracture was taken as dependent variables to analyze the independent risk factors of pelvic fracture combined with humerus fracture. The results showed that age ( P = 0.006; 95%CI = 0.087–0.665; OR = 10.258), ISS ( P = 0.002; 95%CI = 1.839–4.445; OR = 8.721), fracture Tile classification scores ( P = 0.01; 95%CI = 22.554–87.419; OR = 22.736) is a risk factor for pelvic fracture combined with humeral fracture. BMI ( P = 0.627; 95%CI = 0.524–2.88; OR = 1.381) was not a risk factor for pelvic fracture combined with humeral fracture. Logistic analysis showed that age > 60 years old, Tile B2 type or above and high ISS were independent risk factors for pelvic fracture complicated with humeral fracture. Therefore, clinicians should be highly alert to whether humeral fractures occur at the same time in patients with pelvic fractures > 60 years old, Tile B2 type or above and high ISS (Table. 4). Discussion A retrospective study was conducted on the clinical data of 254 cases of pelvic fracture hospitalized in the department of Orthopedics of our hospital from August 2017 to August 2021. Univariate and Logistic analysis of risk factors showed that: Age > 60 years, Tile type B2 or higher, and high ISS were independent risk factors for pelvic fracture complicated with humerus fracture, while BMI, injury cause, and gender were not independent risk factors for pelvic fracture combined with humerus fracture. In this study, we retrospectively collected nearly three years of 254 patients with pelvic fractures were admitted in our hospital orthopedics, among them, 24 cases of pelvic fractures combination with humerus fracture, for most of all a single combined injury, and after the single factor analysis respectively, statistically significant only the pelvic fractures combination of humerus fracture. This discovery has not been mentioned in previous literature reports[ 1 , 2 , 4 – 10 , 12 – 23 ]. The results of counting the causes of injuries show that there are 115 cases of car accidents, 79 cases of falls, 48 cases of high falls and 12 cases of crush injuries. The injury mechanism was analyzed, and it was found that when patients suffered from pelvic fracture, most patients would fall to the ground on the side, resulting in shoulder or elbow joint landing, resulting in humeral fracture. Shoulder joint landing is common, so the probability of proximal humeral fracture is high[ 19 ]. On the basis of screening out that pelvic fracture combined with humeral fracture accounts for the highest proportion in all single pelvic fracture combined injuries, and has statistical significance, we also made logistic analysis on the related risk factors of pelvic fracture combined with humeral fracture. In logistic analysis, we tested the likelihood ratio test (LR), odds ratio (OR), confidence interval (95%CI), probability (P) and other indicators, thus avoiding the error caused by single indicator analysis. Why age, ISS score and Tile score of pelvic fracture would be independent risk factors was analyzed by referring to a large number of literatures, and the results are as follows: 1. Age factor In the data analysis of Table. 2, we found that the probability of humeral fracture combined with injury in patients with pelvic fracture over 60 years old ( P = 0.006; 95%CI = 0.087–0.665; OR = 10.258) was significantly larger than that of patients with pelvic fracture aged < 60 years. This may be related to patients' old age, poor bone condition and brittle fracture after osteoporosis. Court-Brown et al.[ 13 ] reported the findings of a 5-year prospective epidemiological study of 1,027 proximal humeral fractures in Edinburgh, UK. Humeral fractures in patients aged 65 years account for 73% of all humeral fractures, with the highest incidence occurring in women aged 80–89 years and less than 20% of fractures occurring in patients younger than 50 years. Breuil et al.[ 23 ] found through a large number of epidemiological studies that the incidence of senile osteoporotic pelvic fractures is related to age and gender: there are more women than men, and the incidence increases with age. After the elderly patients with pelvic fracture and humeral fracture, because the elderly are not sensitive to pain, the patients stay in bed for a long time after the fracture, and there are not many opportunities for upper limb exertion. When the proximal humeral fracture (Neer type I or II) occurs, the humeral shaft is intact, and the upper limb movement is only slightly limited, clinicians tend to ignore the existence of pelvic fracture and injuries, and miss the diagnosis of humeral fracture[ 16 ]. In order to avoid missed diagnosis, it is particularly important to ask the patient's medical history and physical examination at the time of admission. Elderly patients should also take into account the sensitivity and responsiveness to pain and the mental state after injury, and have a careful physical examination[ 3 ]. 2. Injury severity score (ISS) ISS fully reflected the intensity of violence at the time of injury, and the statistical results of this group ( P = 0.002; 95%CI = 1.839 4.445; OR = 8.721) showed that the greater the degree of trauma, the higher the incidence of humeral fractures in patients with pelvic fractures (Table. 4). When the body is subjected to violence, on the one hand, individuals instinctively extend their upper limbs for support, and the violence reaches the upper arm through conduction, which may lead to a humeral fracture. On the other hand, as the protruding part of the body, the bilateral shoulders are more vulnerable to the impact of the violence that causes the humeral fracture at the moment when the trauma force causes the body to fly out and touch the ground. When the shoulder joint is dislocated, proximal humerus fractures are likely due to rotator cuff pull [ 10 ]. Bao-guo Jiang et al.[ 11 ] believed that there are two age peaks in patients with humeral fracture, which are around 30 years old and over 60 years old respectively, and humeral fracture around 30 years old is mostly caused by high-energy injury. 3. Tile classification score of pelvic fracture In this group, the pelvic fractures were classified by Tile B2 or above ( P = 0.01; 95%CI = 22.554–87.419; OR = 22.736) is significantly higher than that of patients with Tile B2 or below (Table. 4). After analyzing the injury mechanism of patients corresponding to the Tile scores of each pelvic fracture, it was found that the injury mechanism was firstly directly related to the great violence suffered by the body during the trauma[ 9 ]; Secondly, in patients with high Tile classification of pelvic fractures, the violence suffered by trauma is often not unidirectional, and multi-directional violence is more likely to cause multiple fractures, while humeral fractures have the highest incidence among pelvic fractures combined with injuries[ 24 ]. In clinical work, patients with severe pelvic fractures are often combined with hemodynamic instability and damage to the thoracic and abdominal internal organs, which is life-threatening. at this time, saving life is the first element[ 4 ]. Patients often enter the intensive care unit for treatment after thoracic, abdominal or craniocerebral operations, while orthopedic treatment is often the last treatment to exclude other combined injuries. At this time, it is more likely to miss the diagnosis of fractures in other parts with unclear malformations[ 17 ]. Therefore, for severe pelvic fractures, when we pay attention to the pelvic fractures and life-threatening combined injuries, we should also pay attention to the timely detection of non-fatal combined injuries, such as humerus fractures, and early treatment, so as to strive to achieve the best curative effect for patients[ 12 ]. In this study, the clinical data of 254 cases of pelvic fractures in the past three years were collected and analyzed by univariate and logistic analysis, but there are still many shortcomings. First, this study is a single center, which can only represent the situation of patients with pelvic fractures in this area, but can't cover all the risk factors. Secondly, the sample size is relatively small, which has the disadvantage of insufficient sample size, and the collected data may have selective deviation; Third, the accuracy of the definition of the assignment of some variables needs further evaluation; Fourthly, this study is a retrospective study and does not further track the treatment and prognosis of patients, which has an impact on the authenticity of the results. Therefore, a multi-center, long-term prospective study combined with multiple hospitals is needed in order to provide more convincing evidence. Also, is there a statistical significance of pelvic fractures with other single injuries as the sample size increases? And are there other independent risk factors for pelvic fractures combined with humerus fractures? These all need to be further studied before they can be confirmed. Conclusion The combination of pelvic fracture and humerus fracture was statistically significant, and age > 60 years old, pelvic fracture Tile B2 classification above and high ISS were the independent risk factors for humerus fracture in pelvic fracture. Therefore, in clinical work, when clinicians treat patients with pelvic fractures aged > 60 years old, Tile B2 type above classification of pelvic fractures and high ISS, they should be highly vigilant about whether the humerus fractures are accompanied. Abbreviations The full name abbreviations injury severity score ISS body mass index BMI Declarations Ethics approval and consent to participate This study has been approved by the Medical Ethics Committee of Chengdu Fifth People’s Hospital. All patients were informed of the risks and benefits of the trial, gave their consent and signed an informed consent. Consent for publication All participants in the study agreed to the publication of the paper. Availability of data and materials All the data were from the Department of Orthopedic surgery of Chengdu Fifth People's Hospital. Therefore, all data and materials in this article are available. Competing Interests The authors declare that they have no competing interest. Funding This work was supported by Scientific research project of Sichuan Provincial Health and Family Planning Commission（grant No. 18PJ480）. Authors' contributions Xing Chen, Zhengjiang Li and Yan Zhang were responsible for the design of the study, Zhengjiang Li, Shuxing Xing, Yongkui Li and Shunqiang Li are responsible for data collection, sorting and analysis. Zhengjiang Li, Xing Chen and Haibo Ji were responsible for the writing and revision of the paper. Acknowledgements Thanks to all the medical staff of orthopedics department of Chengdu Fifth People's Hospital for their contribution to the data collection of the study. References 1. Nasef H, Elhessy A, Abushaban F, Alhammoud A. Pelvic fracture instability-associated L5 transverse process fracture, fact or myth? A systematic review and meta-analysis. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 28(5): 885-891, 2018 2. Pelleray C. [Protrusion of the femoral vessels into the obturator foramen associated with fracture of the pelvis. Surgical treatment]. Journal de chirurgie 112(5): 161-164, 1976 3. 王颢, 吴新宝. 老年骨质疏松性骨盆骨折(二) %J 中华创伤骨科杂志. 19(12): 1099-1104, 2017 4. Bakhshayesh P, Weidenhielm L, Enocson A. Factors affecting mortality and reoperations in high-energy pelvic fractures. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 28(7): 1273-1282, 2018 5. Ismail HD, Lubis MF, Djaja YP. 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Current opinion in rheumatology 28(4): 442-447, 2016 24. 江利冰, 蒋守银, 赵小纲, 张茂. 世界急诊外科学会骨盆骨折分型及处理指南 %J 中华急诊医学杂志. 26(03): 268-269, 2017 Tables Table. 1 254 cases of pelvic fracture complicated with injury Combined injury Cases (n) P Urethral injury 8 0.778 Craniocerebral injury 11 0.224 Spleen rupture 4 3.457 Liver rupture 2 8.554 Digestive tract injury (perforation) 2 8.554 Hemopneumothorax (lung contusion, rib fracture) 12 0.119 Humerus fractures 24 0.014 Spinal fractures 10 0.624 Femoral fractures 7 0.847 Tibial (fibular) fracture 8 0.778 Forearm and foot fracture 5 2.114 Others 2 8.554 Note: some cases have multiple combined injuries Table. 2 Each factor grouping and variable value definition Factors Variable Evaluation Gender a Male＝1，Female＝0 Age b Age 60 years=0 BMI c BMI>25Kg/m2=1，BMI≤25Kg/m2=0 ISS d ISS>16=1，ISS≤16=0 Tile classification score e Tile type B2 below =1, B2 above =0 Cause of injury f Fall injury =1, other injuries =0 Table. 3 Univariate analysis of pelvic fracture combined with humerus fracture Factors Pelvic fracture without humerus fracture (n) Pelvic fracture with humerus fracture (n) X2 P Gender Male 123 10 0.832 1.03 Female 107 14 Age 60 years 91 16 BMI >25Kg/m2 128 15 0.985 0.437 ≤25Kg/m2 102 9 ISS >16 114 18 43.167 <0.01 ≤16 116 6 Tile typing score B2 blow 118 7 87.554 0.02 B2 above 112 17 Cause of injury Fall injury 114 13 1.149 3.04 Other injuries 116 11 Table. 4 Logistic Analysis of Pelvic Fracture Combined with Humeral Fracture Factors β LR OR 95%CI P Age -1.428 10.258 0.324 0.087-0.665 0.006 BMI 0.335 0.225 1.381 0.524-2.880 0.627 ISS 1.664 8.721 5.587 1.839-4.445 0.002 Tile typing score -3.581 15.846 22.736 22.554-87.419 0.01 Note: The trauma severity score(ISS), the likelihood ratio test (LR), the ratio(OR), the confidence interval(95%CI) Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1604358","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":132982068,"identity":"39919ffb-9c76-496f-b27b-a71937f76842","order_by":0,"name":"Zhengjiang Li","email":"","orcid":"","institution":"Department of Orthopedic Surgery, Chengdu Fifth People's Hospital, The Fifth People's Hospital of Chengdu University of TCM","correspondingAuthor":false,"prefix":"","firstName":"Zhengjiang","middleName":"","lastName":"Li","suffix":""},{"id":132982069,"identity":"84ca3af1-e0e5-496d-9dc3-35552db3709f","order_by":1,"name":"Xing Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYDACZiBmbGBgYGNmPvhAosKGh5+/gUgt/OxtyQYWZ9JkJGccIMImkBbJnjNmEpVth20MGhLwqzY4znv4xc8dNnkGN3LMJG62necxYDjA+OFjDm4tks18aZa9Z9KKDW6kFVvOOHebx5y5gVly5jbcWviZecyMGdsOJ264kbzxtkTZbR7LhgNszLx4tLBBtPwHakkwkP7Ddo7H4EACfi1AW4wfM7YdSJzZc8RIQqLtAGEtks08Zoy9bcmJ/aBAljiTzCM542AzXr8YnD9j/OFnm11iGyQq7ez5+ZsPfviIRwvIOxJoAqBowg+YPxBSMQpGwSgYBSMcAACys1VZd7673QAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Orthopedic Surgery, Chengdu Fifth People's Hospital, The Fifth People's Hospital of Chengdu University of TCM","correspondingAuthor":true,"prefix":"","firstName":"Xing","middleName":"","lastName":"Chen","suffix":""},{"id":132982070,"identity":"6054caf8-fd3f-4511-807c-7dd1b2d5d043","order_by":2,"name":"Yan Zhang","email":"","orcid":"","institution":"General family medicine, Chengdu Fifth People's Hospital, The Fifth People's Hospital of Chengdu University of TCM","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Zhang","suffix":""},{"id":132982071,"identity":"511d6f34-b9de-46ad-86da-a753e28e9a80","order_by":3,"name":"Shunqiang Li","email":"","orcid":"","institution":"Department of Orthopedic Surgery, Chengdu Fifth People's Hospital, The Fifth People's Hospital of Chengdu University of TCM","correspondingAuthor":false,"prefix":"","firstName":"Shunqiang","middleName":"","lastName":"Li","suffix":""},{"id":132982072,"identity":"2a8ea07d-838c-4f73-8ba3-5261abc03cb6","order_by":4,"name":"Haibo Ji","email":"","orcid":"","institution":"Department of Orthopedic Surgery, Chengdu Fifth People's Hospital, The Fifth People's Hospital of Chengdu University of TCM","correspondingAuthor":false,"prefix":"","firstName":"Haibo","middleName":"","lastName":"Ji","suffix":""},{"id":132982073,"identity":"7345bd83-cfee-4bc4-9f87-e9ecb9cd12f9","order_by":5,"name":"Yongkui Li","email":"","orcid":"","institution":"Department of Orthopedic Surgery, Chengdu Fifth People's Hospital, The Fifth People's Hospital of Chengdu University of TCM","correspondingAuthor":false,"prefix":"","firstName":"Yongkui","middleName":"","lastName":"Li","suffix":""},{"id":132982074,"identity":"85dd7d09-3bba-4457-8192-d0d4e2c274aa","order_by":6,"name":"Shuxing Xing","email":"","orcid":"","institution":"Department of Orthopedic Surgery, Chengdu Fifth People's Hospital, The Fifth People's Hospital of Chengdu University of TCM","correspondingAuthor":false,"prefix":"","firstName":"Shuxing","middleName":"","lastName":"Xing","suffix":""}],"badges":[],"createdAt":"2022-04-28 10:29:10","currentVersionCode":2,"declarations":"","doi":"10.21203/rs.3.rs-1604358/v2","doiUrl":"https://doi.org/10.21203/rs.3.rs-1604358/v2","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":25951744,"identity":"aa47cd1c-1937-4089-8852-04b37b113e5b","added_by":"auto","created_at":"2022-09-01 20:05:06","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":143422,"visible":true,"origin":"","legend":"\u003cp\u003eA patient with car accident trauma presented with simultaneous pelvic fracture and greater tuberosity fracture of the humerus. In our patient's emergency department, no fracture of the greater tuberosity of the humerus was identified. After admission, we screened the X-ray of the humerus based on her inclusion in the study and found that she had a pelvic fracture with a greater tuberosity fracture. Figure A shows a greater tuberosity fracture and Figure B shows a pelvic fracture (Tile Type B2.2).\u0026nbsp;\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1604358/v2/442047f11dd93dd8419d2eb3.jpg"},{"id":26675162,"identity":"3c34e2f6-3094-4ea2-8f79-94417b99f144","added_by":"auto","created_at":"2022-09-19 21:44:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":360026,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1604358/v2/4b1abf7e-dab4-4249-9641-cb192fcbd7fa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk factors of pelvic fracture combined with humeral fracture: A retrospective study","fulltext":[{"header":"Background","content":"\u003cp\u003ePelvic fractures are mostly caused by high energy injuries, such as falling from a height or car collision caused by fractures, pelvic fractures accounted for 2.8%. In addition, 20% of multiple trauma patients with blunt trauma also had pelvic injury[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Of all musculoskeletal injuries, pelvic fractures are considered to be the leading cause of death and morbidity. According to statistics, the incidence of pelvic fracture accounted for 1%~3% of the total number of systemic fractures, its disability rate was 50%~60%, and its fatality rate was as high as 10%~25%[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The mortality associated with open unstable pelvic fractures is approximately 20%, while the mortality associated with open fractures alone is approximately 50%. The incidence of pelvic fractures is reported to be 17\u0026ndash;37/100,000 persons/year, and the incidence of high-energy pelvic fractures is reported to be 10/100,000 persons/year. High energy pelvic fractures have traditionally been considered serious injuries, leading to a mortality rate of 47% in patients with multiple trauma[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In Rothenberg et al. 's study of 31 open pelvic injuries, the reported mortality was 42%[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBecause the patient of pelvic fracture is often traumatized by great violence, often the serious trauma of other organization and organ is combined, the incidence rate of shock is as high as 30% above. However, once hemodynamic instability occurs after injury, it can significantly increase the mortality of patients. Death rates in patients reporting shock, such as Starr, can be as high as 57%[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, for non-severe pelvic fractures, clinicians tend to pay attention to the complications related to pelvic fractures in addition to the fracture itself, which is easy to cause serious consequences and affect the subsequent diagnosis and treatment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].Therefore, considering the high energy forces of pelvic injury, it is crucial to anticipate other related injuries in different body parts and systems. In addition, the assessment of patients with traumatic pelvic injury should not be taken lightly and the injury should not always be treated as an isolated case. Up to 60% of patients with pelvic injuries have long bone fractures, spinal fractures, head injuries, abdominal organ injuries or nervous system injuries[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Proximal humeral fractures are common, accounting for 4.6% of all fractures. They are mostly related to osteoporosis, with 78% of fractures occurring in older patients over the age of 65[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen a pelvic fracture is associated with a humerus fracture, the pain of the humerus fracture may not be obvious because the patient is bedridden and has little movement of the upper limb. Therefore, when pelvic fracture combined with humeral fracture, orthopedic surgeons and patients tend to pay more attention to the pelvis and easily ignore the humerus, resulting in missed diagnosis and delayed treatment, resulting in serious consequences. To clarify the clinical characteristics and risk factors of patients with pelvic fracture combined with humeral fracture is of great clinical significance for early detection and timely treatment of humeral fracture. Therefore, this study aims to retrospectively study the patients with pelvic fracture admitted to our department in recent 3 years, analyze the risk factors of pelvic fracture combined with humerus fracture, and provide evidence-based medical evidence for clinicians to be vigilant of combined humerus fracture when treating patients with pelvic fracture.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003eIn this retrospective study, we collected 254 patients with pelvic fractures who were treated at Department of Orthopedic Surgery, Chengdu Fifth People\u0026rsquo;s Hospital from August 2017 to August 2021. This study has been approved by the Medical Ethics Committee of Chengdu Fifth People\u0026rsquo;s Hospital, and all patients were informed of the risks and benefits of the trial, gave their consent and signed an informed consent. The outcome indicators were measured on the Neusoft PACS. Inclusion criteria: ① Pelvic fractures with a clear history of trauma; ② Complete clinical and imaging materials (X - ray and 3D-CT). Exclusion criteria: ① Pathological fracture; ② Old pelvic fracture or old humeral fracture; ③ Pelvic fracture and humeral fracture are not the same injury; ④ The accuracy of the results is affected by factors such as inability to judge or incomplete data.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eData were collected by two independent investigators, including general baseline information (gender, age, body mass index (BMI), cause of injury, and underlying disease), imaging data (pelvic X-ray and 3D-CT, humeral X-ray and 3D-CT), and injury severity score (ISS). The pelvic fractures were Tile typed and recorded by two independent, senior physicians based on the patient's radiographic data and counted by a third independent investigator (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the event of inconsistent results, the decision will be made jointly by the three independent investigators. Main outcome measures: Tile classification of pelvic fractures, number of humeral fractures, and ISS.\u003c/p\u003e \u003cp\u003eSecondary outcome measures: gender, age, BMI, cause of injury, underlying diseases, etc.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eGender, age, BMI, ISS, cause of injury and Tile classification of pelvic fracture were used as independent variables, and pelvic fracture combined with humeral fracture was used as dependent variables (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). See Table\u0026nbsp;1 for the assignment of variables. The independent T test was first used for univariate analysis (Table\u0026nbsp;3), and then the screened variables with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were analyzed by logistic analysis to determine risk factors. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to be statistically significant. SPSS 23.0 (IBM Corp., USA) software was used for statistical analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation analysis of pelvic fracture with humeral fracture\u003c/h2\u003e \u003cp\u003eA total of 254 patients were included in this study, including 133 males, accounting for 52.36%; 121 cases were female (47.64%). The age range was 10\u0026ndash;91 years, with an average of 50.6 years. Among the injury causes, 115 cases were car accident injury, 79 cases were fall injury, 48 cases were high fall injury, 12 cases were crush injury. There were 143 cases with BMI\u0026thinsp;\u0026gt;\u0026thinsp;25Kg/m\u003csup\u003e2\u003c/sup\u003e and 111 cases with BMI\u0026thinsp;\u0026lt;\u0026thinsp;25Kg/m\u003csup\u003e2\u003c/sup\u003e. Tile classification of pelvic fractures: 116 cases of type A, 85 cases of type B and 53 cases of type C (Table. 3).\u003c/p\u003e \u003cp\u003eThere were 24 patients with pelvic fracture combined with humeral fracture, accounting for 9.45% of all combined injuries, far higher than other patients with single combined injuries, and only pelvic fracture combined with humeral fracture had statistical significance (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.014) (Table. 2), indicating the correlation between pelvic fracture combined with humeral fracture. Age (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01), fracture Tile classification (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02), ISS score (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), but there was no statistical significance in gender (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.03), BMI (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.437) and injury cause (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.04) (Table\u0026nbsp;3). It is suggested that age, fracture Tile classification and ISS are the risk factors of pelvic fracture combined with humerus fracture, while gender, BMI and injury cause have little influence on the incidence of pelvic fracture combined with humerus fracture.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLogistic analysis of risk factors for pelvic fracture associated with humeral fracture\u003c/h2\u003e \u003cp\u003eIn logistic analysis of pelvic fracture combined with humerus fracture, age, ISS and fracture Tile classification score were taken as independent variables, and pelvic fracture combined with humerus fracture was taken as dependent variables to analyze the independent risk factors of pelvic fracture combined with humerus fracture. The results showed that age (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006; 95%CI\u0026thinsp;=\u0026thinsp;0.087\u0026ndash;0.665; OR\u0026thinsp;=\u0026thinsp;10.258), ISS (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002; 95%CI\u0026thinsp;=\u0026thinsp;1.839\u0026ndash;4.445; OR\u0026thinsp;=\u0026thinsp;8.721), fracture Tile classification scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01; 95%CI\u0026thinsp;=\u0026thinsp;22.554\u0026ndash;87.419; OR\u0026thinsp;=\u0026thinsp;22.736) is a risk factor for pelvic fracture combined with humeral fracture. BMI (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.627; 95%CI\u0026thinsp;=\u0026thinsp;0.524\u0026ndash;2.88; OR\u0026thinsp;=\u0026thinsp;1.381) was not a risk factor for pelvic fracture combined with humeral fracture. Logistic analysis showed that age\u0026thinsp;\u0026gt;\u0026thinsp;60 years old, Tile B2 type or above and high ISS were independent risk factors for pelvic fracture complicated with humeral fracture. Therefore, clinicians should be highly alert to whether humeral fractures occur at the same time in patients with pelvic fractures\u0026thinsp;\u0026gt;\u0026thinsp;60 years old, Tile B2 type or above and high ISS (Table. 4).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eA retrospective study was conducted on the clinical data of 254 cases of pelvic fracture hospitalized in the department of Orthopedics of our hospital from August 2017 to August 2021. Univariate and Logistic analysis of risk factors showed that: Age\u0026thinsp;\u0026gt;\u0026thinsp;60 years, Tile type B2 or higher, and high ISS were independent risk factors for pelvic fracture complicated with humerus fracture, while BMI, injury cause, and gender were not independent risk factors for pelvic fracture combined with humerus fracture. In this study, we retrospectively collected nearly three years of 254 patients with pelvic fractures were admitted in our hospital orthopedics, among them, 24 cases of pelvic fractures combination with humerus fracture, for most of all a single combined injury, and after the single factor analysis respectively, statistically significant only the pelvic fractures combination of humerus fracture. This discovery has not been mentioned in previous literature reports[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The results of counting the causes of injuries show that there are 115 cases of car accidents, 79 cases of falls, 48 cases of high falls and 12 cases of crush injuries. The injury mechanism was analyzed, and it was found that when patients suffered from pelvic fracture, most patients would fall to the ground on the side, resulting in shoulder or elbow joint landing, resulting in humeral fracture. Shoulder joint landing is common, so the probability of proximal humeral fracture is high[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. On the basis of screening out that pelvic fracture combined with humeral fracture accounts for the highest proportion in all single pelvic fracture combined injuries, and has statistical significance, we also made logistic analysis on the related risk factors of pelvic fracture combined with humeral fracture. In logistic analysis, we tested the likelihood ratio test (LR), odds ratio (OR), confidence interval (95%CI), probability (P) and other indicators, thus avoiding the error caused by single indicator analysis.\u003c/p\u003e \u003cp\u003eWhy age, ISS score and Tile score of pelvic fracture would be independent risk factors was analyzed by referring to a large number of literatures, and the results are as follows:\u003c/p\u003e \u003cp\u003e1. Age factor\u003c/p\u003e \u003cp\u003eIn the data analysis of Table. 2, we found that the probability of humeral fracture combined with injury in patients with pelvic fracture over 60 years old (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006; 95%CI\u0026thinsp;=\u0026thinsp;0.087\u0026ndash;0.665; OR\u0026thinsp;=\u0026thinsp;10.258) was significantly larger than that of patients with pelvic fracture aged\u0026thinsp;\u0026lt;\u0026thinsp;60 years. This may be related to patients' old age, poor bone condition and brittle fracture after osteoporosis. Court-Brown et al.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] reported the findings of a 5-year prospective epidemiological study of 1,027 proximal humeral fractures in Edinburgh, UK. Humeral fractures in patients aged 65 years account for 73% of all humeral fractures, with the highest incidence occurring in women aged 80\u0026ndash;89 years and less than 20% of fractures occurring in patients younger than 50 years. Breuil et al.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] found through a large number of epidemiological studies that the incidence of senile osteoporotic pelvic fractures is related to age and gender: there are more women than men, and the incidence increases with age. After the elderly patients with pelvic fracture and humeral fracture, because the elderly are not sensitive to pain, the patients stay in bed for a long time after the fracture, and there are not many opportunities for upper limb exertion. When the proximal humeral fracture (Neer type I or II) occurs, the humeral shaft is intact, and the upper limb movement is only slightly limited, clinicians tend to ignore the existence of pelvic fracture and injuries, and miss the diagnosis of humeral fracture[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In order to avoid missed diagnosis, it is particularly important to ask the patient's medical history and physical examination at the time of admission. Elderly patients should also take into account the sensitivity and responsiveness to pain and the mental state after injury, and have a careful physical examination[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e2. Injury severity score (ISS)\u003c/p\u003e \u003cp\u003eISS fully reflected the intensity of violence at the time of injury, and the statistical results of this group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002; 95%CI\u0026thinsp;=\u0026thinsp;1.839 4.445; OR\u0026thinsp;=\u0026thinsp;8.721) showed that the greater the degree of trauma, the higher the incidence of humeral fractures in patients with pelvic fractures (Table. 4). When the body is subjected to violence, on the one hand, individuals instinctively extend their upper limbs for support, and the violence reaches the upper arm through conduction, which may lead to a humeral fracture. On the other hand, as the protruding part of the body, the bilateral shoulders are more vulnerable to the impact of the violence that causes the humeral fracture at the moment when the trauma force causes the body to fly out and touch the ground. When the shoulder joint is dislocated, proximal humerus fractures are likely due to rotator cuff pull [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Bao-guo Jiang et al.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] believed that there are two age peaks in patients with humeral fracture, which are around 30 years old and over 60 years old respectively, and humeral fracture around 30 years old is mostly caused by high-energy injury.\u003c/p\u003e \u003cp\u003e3. Tile classification score of pelvic fracture\u003c/p\u003e \u003cp\u003eIn this group, the pelvic fractures were classified by Tile B2 or above (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01; 95%CI\u0026thinsp;=\u0026thinsp;22.554\u0026ndash;87.419; OR\u0026thinsp;=\u0026thinsp;22.736) is significantly higher than that of patients with Tile B2 or below (Table. 4). After analyzing the injury mechanism of patients corresponding to the Tile scores of each pelvic fracture, it was found that the injury mechanism was firstly directly related to the great violence suffered by the body during the trauma[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]; Secondly, in patients with high Tile classification of pelvic fractures, the violence suffered by trauma is often not unidirectional, and multi-directional violence is more likely to cause multiple fractures, while humeral fractures have the highest incidence among pelvic fractures combined with injuries[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In clinical work, patients with severe pelvic fractures are often combined with hemodynamic instability and damage to the thoracic and abdominal internal organs, which is life-threatening. at this time, saving life is the first element[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Patients often enter the intensive care unit for treatment after thoracic, abdominal or craniocerebral operations, while orthopedic treatment is often the last treatment to exclude other combined injuries. At this time, it is more likely to miss the diagnosis of fractures in other parts with unclear malformations[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Therefore, for severe pelvic fractures, when we pay attention to the pelvic fractures and life-threatening combined injuries, we should also pay attention to the timely detection of non-fatal combined injuries, such as humerus fractures, and early treatment, so as to strive to achieve the best curative effect for patients[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, the clinical data of 254 cases of pelvic fractures in the past three years were collected and analyzed by univariate and logistic analysis, but there are still many shortcomings. First, this study is a single center, which can only represent the situation of patients with pelvic fractures in this area, but can't cover all the risk factors. Secondly, the sample size is relatively small, which has the disadvantage of insufficient sample size, and the collected data may have selective deviation; Third, the accuracy of the definition of the assignment of some variables needs further evaluation; Fourthly, this study is a retrospective study and does not further track the treatment and prognosis of patients, which has an impact on the authenticity of the results. Therefore, a multi-center, long-term prospective study combined with multiple hospitals is needed in order to provide more convincing evidence. Also, is there a statistical significance of pelvic fractures with other single injuries as the sample size increases? And are there other independent risk factors for pelvic fractures combined with humerus fractures? These all need to be further studied before they can be confirmed.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe combination of pelvic fracture and humerus fracture was statistically significant, and age\u0026thinsp;\u0026gt;\u0026thinsp;60 years old, pelvic fracture Tile B2 classification above and high ISS were the independent risk factors for humerus fracture in pelvic fracture. Therefore, in clinical work, when clinicians treat patients with pelvic fractures aged\u0026thinsp;\u0026gt;\u0026thinsp;60 years old, Tile B2 type above classification of pelvic fractures and high ISS, they should be highly vigilant about whether the humerus fractures are accompanied.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.17283950617284%\"\u003e\n \u003cp\u003eThe full name\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.82716049382716%\"\u003e\n \u003cp\u003eabbreviations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.17283950617284%\"\u003e\n \u003cp\u003einjury severity score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.82716049382716%\"\u003e\n \u003cp\u003eISS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"56.17283950617284%\"\u003e\n \u003cp\u003e\u0026nbsp;body mass index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.82716049382716%\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has been approved by the Medical Ethics Committee of Chengdu Fifth People\u0026rsquo;s Hospital. All patients were informed of the risks and benefits of the trial, gave their consent and signed an informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants in the study agreed to the publication of the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the data were from the Department of Orthopedic surgery of Chengdu Fifth People\u0026apos;s Hospital. Therefore, all data and materials in this article are available.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Scientific research project of Sichuan Provincial Health and Family Planning Commission（grant No. 18PJ480）.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXing Chen, Zhengjiang Li and Yan Zhang were responsible for the design of the study, Zhengjiang Li, Shuxing Xing, Yongkui Li and Shunqiang Li are responsible for data collection, sorting and analysis. Zhengjiang Li, Xing Chen and Haibo Ji were responsible for the writing and revision of the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks to all the medical staff of orthopedics department of Chengdu Fifth People\u0026apos;s Hospital for their contribution to the data collection of the study.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003e1. Nasef H, Elhessy A, Abushaban F, Alhammoud A. Pelvic fracture instability-associated L5 transverse process fracture, fact or myth? A systematic review and meta-analysis. European journal of orthopaedic surgery \u0026amp; traumatology : orthopedie traumatologie 28(5): 885-891, 2018\u003c/p\u003e\n\u003cp\u003e2. Pelleray C. [Protrusion of the femoral vessels into the obturator foramen associated with fracture of the pelvis. Surgical treatment]. Journal de chirurgie 112(5): 161-164, 1976\u003c/p\u003e\n\u003cp\u003e3. 王颢, 吴新宝. 老年骨质疏松性骨盆骨折(二) %J 中华创伤骨科杂志. 19(12): 1099-1104, 2017\u003c/p\u003e\n\u003cp\u003e4. Bakhshayesh P, Weidenhielm L, Enocson A. Factors affecting mortality and reoperations in high-energy pelvic fractures. European journal of orthopaedic surgery \u0026amp; traumatology : orthopedie traumatologie 28(7): 1273-1282, 2018\u003c/p\u003e\n\u003cp\u003e5. Ismail HD, Lubis MF, Djaja YP. The Outcome of Complex Pelvic Fracture after Internal Fixation Surgery. Malaysian orthopaedic journal 10(1): 16-21, 2016\u003c/p\u003e\n\u003cp\u003e6. Starr AJ, Griffin DR, Reinert CM, Frawley WH, Walker J, Whitlock SN, Borer DS, Rao AV, Jones AL. Pelvic ring disruptions: prediction of associated injuries, transfusion requirement, pelvic arteriography, complications, and mortality. Journal of orthopaedic trauma 16(8): 553-561, 2002\u003c/p\u003e\n\u003cp\u003e7. Boyer P, Couffignal C, Bahman M, Mylle G, Rousseau MA, Dukan R. Displaced three and four part proximal humeral fractures: prospective controlled randomized open-label two-arm study comparing intramedullary nailing and locking plate. International orthopaedics 45(11): 2917-2926, 2021\u003c/p\u003e\n\u003cp\u003e8. Tile M. Acute Pelvic Fractures: I. Causation and Classification. The Journal of the American Academy of Orthopaedic Surgeons 4(3): 143-151, 1996\u003c/p\u003e\n\u003cp\u003e9. Davis DD, Foris LA, Kane SM, Waseem M. Pelvic Fracture. In: \u0026nbsp;StatPearls. Treasure Island (FL): StatPearls Publishing\u003c/p\u003e\n\u003cp\u003eCopyright \u0026copy; 2022, StatPearls Publishing LLC. 2022\u003c/p\u003e\n\u003cp\u003e10. Brorson S, Alispahic N, Bahrs C, Joeris A, Steinitz A, Audig\u0026eacute; L. Complications after non-surgical management of proximal humeral fractures: a systematic review of terms and definitions. BMC musculoskeletal disorders 20(1): 91, 2019\u003c/p\u003e\n\u003cp\u003e11. 姜保国, 陈建海. 肱骨近端骨折的治疗进展 %J 北京大学学报(医学版). 47(02): 197-199, 2015\u003c/p\u003e\n\u003cp\u003e12. Murena L, Canton G, Hoxhaj B, Sborgia A, Fattori R, Gulli S, Vaienti E. Early weight bearing in acetabular and pelvic fractures. Acta bio-medica : Atenei Parmensis 92(4): e2021236, 2021\u003c/p\u003e\n\u003cp\u003e13. Court-Brown CM, Garg A, McQueen MM. The epidemiology of proximal humeral fractures. Acta orthopaedica Scandinavica 72(4): 365-371, 2001\u003c/p\u003e\n\u003cp\u003e14. Kristiansen B, Barfod G, Bredesen J, Erin-Madsen J, Grum B, Horsnaes MW, Aalberg JR. Epidemiology of proximal humeral fractures. Acta orthopaedica Scandinavica 58(1): 75-77, 1987\u003c/p\u003e\n\u003cp\u003e15. Vallier HA, Cureton BA, Patterson BM. Factors affecting revenue from the management of pelvis and acetabulum fractures. Journal of orthopaedic trauma 27(5): 267-274, 2013\u003c/p\u003e\n\u003cp\u003e16. Neer CS, 2nd. Four-segment classification of proximal humeral fractures: purpose and reliable use. Journal of shoulder and elbow surgery 11(4): 389-400, 2002\u003c/p\u003e\n\u003cp\u003e17. Goldman RT, Koval KJ, Cuomo F, Gallagher MA, Zuckerman JD. Functional outcome after humeral head replacement for acute three- and four-part proximal humeral fractures. Journal of shoulder and elbow surgery 4(2): 81-86, 1995\u003c/p\u003e\n\u003cp\u003e18. Tile M. Pelvic ring fractures: should they be fixed? The Journal of bone and joint surgery British volume 70(1): 1-12, 1988\u003c/p\u003e\n\u003cp\u003e19. Brorson S, Palm H. Proximal Humeral Fractures: The Choice of Treatment. In: Falaschi P, Marsh D, eds. Orthogeriatrics: The Management of Older Patients with Fragility Fractures. Cham (CH): Springer\u003c/p\u003e\n\u003cp\u003eCopyright 2021, The Author(s). 143-153. 2021\u003c/p\u003e\n\u003cp\u003e20. Court-Brown CM, Garg A, McQueen MM. The translated two-part fracture of the proximal humerus. Epidemiology and outcome in the older patient. The Journal of bone and joint surgery British volume 83(6): 799-804, 2001\u003c/p\u003e\n\u003cp\u003e21. Patel DN, Fok CS, Webster GD, Anger JT. Female urethral injuries associated with pelvic fracture: a systematic review of the literature. BJU international 120(6): 766-773, 2017\u003c/p\u003e\n\u003cp\u003e22. Rommens PM, Wagner D, Hofmann A. Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis. Chirurgia (Bucharest, Romania : 1990) 112(5): 524-537, 2017\u003c/p\u003e\n\u003cp\u003e23. Breuil V, Roux CH, Carle GF. Pelvic fractures: epidemiology, consequences, and medical management. Current opinion in rheumatology 28(4): 442-447, 2016\u003c/p\u003e\n\u003cp\u003e24. 江利冰, 蒋守银, 赵小纲, 张茂. 世界急诊外科学会骨盆骨折分型及处理指南 %J 中华急诊医学杂志. 26(03): 268-269, 2017\u003c/p\u003e"},{"header":"Tables","content":"\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"489\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" colspan=\"3\" height=\"43\" rowspan=\"2\" width=\"100%\"\u003eTable. 1 254 cases of pelvic fracture complicated with injury\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl64\" height=\"23\" width=\"47.648261758691206%\"\u003eCombined injury\u003c/td\u003e\n \u003ctd class=\"xl64\" width=\"25.562372188139058%\"\u003eCases (n)\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"26.789366053169733%\"\u003eP\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"22\" width=\"47.648261758691206%\"\u003eUrethral injury\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"25.562372188139058%\"\u003e8\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"26.789366053169733%\"\u003e0.778\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"21\" width=\"47.648261758691206%\"\u003eCraniocerebral injury\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"25.562372188139058%\"\u003e11\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"26.789366053169733%\"\u003e0.224\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"21\" width=\"47.648261758691206%\"\u003eSpleen rupture\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"25.562372188139058%\"\u003e4\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"26.789366053169733%\"\u003e3.457\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"21\" width=\"47.648261758691206%\"\u003eLiver rupture\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"25.562372188139058%\"\u003e2\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"26.789366053169733%\"\u003e8.554\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"21\" width=\"47.648261758691206%\"\u003eDigestive tract injury (perforation)\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"25.562372188139058%\"\u003e2\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"26.789366053169733%\"\u003e8.554\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"42\" width=\"47.648261758691206%\"\u003eHemopneumothorax (lung contusion, rib fracture)\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"25.562372188139058%\"\u003e12\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"26.789366053169733%\"\u003e0.119\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"21\" width=\"47.648261758691206%\"\u003eHumerus fractures\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"25.562372188139058%\"\u003e24\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"26.789366053169733%\"\u003e0.014\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"21\" width=\"47.648261758691206%\"\u003eSpinal fractures\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"25.562372188139058%\"\u003e10\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"26.789366053169733%\"\u003e0.624\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"21\" width=\"47.648261758691206%\"\u003eFemoral fractures\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"25.562372188139058%\"\u003e7\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"26.789366053169733%\"\u003e0.847\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"21\" width=\"47.648261758691206%\"\u003eTibial (fibular) fracture\u0026nbsp;\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"25.562372188139058%\"\u003e8\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"26.789366053169733%\"\u003e0.778\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"21\" width=\"47.648261758691206%\"\u003eForearm and foot fracture\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"25.562372188139058%\"\u003e5\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"26.789366053169733%\"\u003e2.114\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"21\" width=\"47.648261758691206%\"\u003eOthers\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"25.562372188139058%\"\u003e2\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"26.789366053169733%\"\u003e8.554\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl66\" colspan=\"3\" height=\"22\" width=\"100%\"\u003eNote: some cases have multiple combined injuries\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"524\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl64\" colspan=\"3\" height=\"43\" rowspan=\"2\" width=\"100%\"\u003eTable. 2 Each factor grouping and variable value definition\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"23\" width=\"26.908396946564885%\"\u003eFactors\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"19.46564885496183%\"\u003eVariable\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"53.62595419847328%\"\u003eEvaluation\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl64\" height=\"22\" width=\"26.908396946564885%\"\u003eGender\u003c/td\u003e\n \u003ctd class=\"xl64\" width=\"19.46564885496183%\"\u003ea\u003c/td\u003e\n \u003ctd class=\"xl64\" width=\"53.62595419847328%\"\u003eMale＝1，Female＝0\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl64\" height=\"21\" width=\"26.908396946564885%\"\u003eAge\u003c/td\u003e\n \u003ctd class=\"xl64\" width=\"19.46564885496183%\"\u003eb\u003c/td\u003e\n \u003ctd class=\"xl64\" width=\"53.62595419847328%\"\u003eAge \u0026lt; 60 years=1, age \u0026gt; 60 years=0\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl64\" height=\"21\" width=\"26.908396946564885%\"\u003eBMI\u0026nbsp;\u003c/td\u003e\n \u003ctd class=\"xl64\" width=\"19.46564885496183%\"\u003ec\u003c/td\u003e\n \u003ctd class=\"xl64\" width=\"53.62595419847328%\"\u003eBMI\u0026gt;25Kg/m2=1，BMI\u0026le;25Kg/m2=0\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl64\" height=\"21\" width=\"26.908396946564885%\"\u003eISS\u003c/td\u003e\n \u003ctd class=\"xl64\" width=\"19.46564885496183%\"\u003ed\u003c/td\u003e\n \u003ctd class=\"xl64\" width=\"53.62595419847328%\"\u003eISS\u0026gt;16=1，ISS\u0026le;16=0\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl64\" height=\"42\" width=\"26.908396946564885%\"\u003eTile classification score\u0026nbsp;\u003c/td\u003e\n \u003ctd class=\"xl64\" width=\"19.46564885496183%\"\u003ee\u003c/td\u003e\n \u003ctd class=\"xl64\" width=\"53.62595419847328%\"\u003eTile type B2 below =1, B2 above =0\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"22\" width=\"26.908396946564885%\"\u003eCause of injury\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"19.46564885496183%\"\u003ef\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"53.62595419847328%\"\u003eFall injury =1, other injuries =0\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"523\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" colspan=\"5\" height=\"41\" rowspan=\"2\" width=\"100%\"\u003eTable. 3 Univariate analysis of pelvic fracture combined with humerus fracture\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"65\" width=\"22.37093690248566%\"\u003eFactors\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"25.621414913957935%\"\u003ePelvic fracture without humerus fracture (n)\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"23.709369024856596%\"\u003ePelvic fracture with humerus fracture (n)\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"13.766730401529637%\"\u003eX2\u003c/td\u003e\n \u003ctd class=\"xl64\" width=\"14.531548757170173%\"\u003eP\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"22\" width=\"22.37093690248566%\"\u003eGender\u003c/td\u003e\n \u003ctd class=\"xl65\" colspan=\"4\" width=\"77.62906309751435%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"22.37093690248566%\"\u003e\u0026nbsp; Male\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"25.621414913957935%\"\u003e123\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"23.709369024856596%\"\u003e10\u003c/td\u003e\n \u003ctd class=\"xl65\" rowspan=\"2\" width=\"13.766730401529637%\"\u003e0.832\u003c/td\u003e\n \u003ctd class=\"xl65\" rowspan=\"2\" width=\"14.531548757170173%\"\u003e1.03\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"31.2%\"\u003e\u0026nbsp; Female\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"35.733333333333334%\"\u003e107\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"33.06666666666667%\"\u003e14\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"22.37093690248566%\"\u003eAge\u003c/td\u003e\n \u003ctd class=\"xl65\" colspan=\"4\" width=\"77.62906309751435%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"22.37093690248566%\"\u003e\u0026lt;60 years\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"25.621414913957935%\"\u003e139\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"23.709369024856596%\"\u003e8\u003c/td\u003e\n \u003ctd class=\"xl65\" rowspan=\"2\" width=\"13.766730401529637%\"\u003e11.871\u003c/td\u003e\n \u003ctd class=\"xl65\" rowspan=\"2\" width=\"14.531548757170173%\"\u003e0.01\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"31.2%\"\u003e\u0026gt;60 years\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"35.733333333333334%\"\u003e91\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"33.06666666666667%\"\u003e16\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"22.37093690248566%\"\u003eBMI\u0026nbsp;\u003c/td\u003e\n \u003ctd class=\"xl65\" colspan=\"4\" width=\"77.62906309751435%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"22.37093690248566%\"\u003e\u0026nbsp; \u0026gt;25Kg/m2\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"25.621414913957935%\"\u003e128\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"23.709369024856596%\"\u003e15\u003c/td\u003e\n \u003ctd class=\"xl65\" rowspan=\"2\" width=\"13.766730401529637%\"\u003e0.985\u003c/td\u003e\n \u003ctd class=\"xl65\" rowspan=\"2\" width=\"14.531548757170173%\"\u003e0.437\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"31.2%\"\u003e\u0026nbsp; \u0026le;25Kg/m2\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"35.733333333333334%\"\u003e102\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"33.06666666666667%\"\u003e9\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"22.37093690248566%\"\u003eISS\u003c/td\u003e\n \u003ctd class=\"xl65\" colspan=\"4\" width=\"77.62906309751435%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"22.37093690248566%\"\u003e\u0026nbsp; \u0026gt;16\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"25.621414913957935%\"\u003e114\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"23.709369024856596%\"\u003e18\u003c/td\u003e\n \u003ctd class=\"xl65\" rowspan=\"2\" width=\"13.766730401529637%\"\u003e43.167\u003c/td\u003e\n \u003ctd class=\"xl65\" rowspan=\"2\" width=\"14.531548757170173%\"\u003e\u0026nbsp;\u0026lt;0.01\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"31.2%\"\u003e\u0026nbsp; \u0026le;16\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"35.733333333333334%\"\u003e116\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"33.06666666666667%\"\u003e6\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"22.37093690248566%\"\u003eTile typing score\u003c/td\u003e\n \u003ctd class=\"xl65\" colspan=\"4\" width=\"77.62906309751435%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"22.37093690248566%\"\u003e\u0026nbsp; B2 blow\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"25.621414913957935%\"\u003e118\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"23.709369024856596%\"\u003e7\u003c/td\u003e\n \u003ctd class=\"xl65\" rowspan=\"2\" width=\"13.766730401529637%\"\u003e87.554\u003c/td\u003e\n \u003ctd class=\"xl65\" rowspan=\"2\" width=\"14.531548757170173%\"\u003e0.02\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"31.2%\"\u003e\u0026nbsp; B2 above\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"35.733333333333334%\"\u003e112\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"33.06666666666667%\"\u003e17\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"22.37093690248566%\"\u003eCause of injury\u003c/td\u003e\n \u003ctd class=\"xl65\" colspan=\"4\" width=\"77.62906309751435%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"22.37093690248566%\"\u003eFall injury\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"25.621414913957935%\"\u003e114\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"23.709369024856596%\"\u003e13\u003c/td\u003e\n \u003ctd class=\"xl65\" rowspan=\"2\" width=\"13.766730401529637%\"\u003e1.149\u003c/td\u003e\n \u003ctd class=\"xl65\" rowspan=\"2\" width=\"14.531548757170173%\"\u003e3.04\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl66\" height=\"22\" width=\"31.2%\"\u003eOther injuries\u003c/td\u003e\n \u003ctd class=\"xl66\" width=\"35.733333333333334%\"\u003e116\u003c/td\u003e\n \u003ctd class=\"xl66\" width=\"33.06666666666667%\"\u003e11\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"500\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" colspan=\"6\" height=\"48\" rowspan=\"2\" width=\"100%\"\u003eTable. 4 Logistic Analysis of Pelvic Fracture Combined with Humeral Fracture\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl63\" height=\"23\" width=\"22%\"\u003eFactors\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"14%\"\u003e\u0026beta;\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"13%\"\u003eLR\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"13.6%\"\u003eOR\u003c/td\u003e\n \u003ctd class=\"xl63\" width=\"24.2%\"\u003e95%CI\u003c/td\u003e\n \u003ctd class=\"xl64\" width=\"13.2%\"\u003eP\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"22\" width=\"22%\"\u003eAge\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"14%\"\u003e-1.428\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"13%\"\u003e10.258\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"13.6%\"\u003e0.324\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"24.2%\"\u003e0.087-0.665\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"13.2%\"\u003e0.006\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"22%\"\u003eBMI\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"14%\"\u003e0.335\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"13%\"\u003e0.225\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"13.6%\"\u003e1.381\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"24.2%\"\u003e0.524-2.880\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"13.2%\"\u003e0.627\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"22%\"\u003eISS\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"14%\"\u003e1.664\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"13%\"\u003e8.721\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"13.6%\"\u003e5.587\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"24.2%\"\u003e1.839-4.445\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"13.2%\"\u003e0.002\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl65\" height=\"21\" width=\"22%\"\u003eTile typing score\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"14%\"\u003e-3.581\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"13%\"\u003e15.846\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"13.6%\"\u003e22.736\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"24.2%\"\u003e22.554-87.419\u003c/td\u003e\n \u003ctd class=\"xl65\" width=\"13.2%\"\u003e0.01\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd class=\"xl66\" colspan=\"6\" height=\"36\" width=\"100%\"\u003eNote: The trauma severity score(ISS), \u0026nbsp;the likelihood ratio test (LR), \u0026nbsp;the ratio(OR), \u0026nbsp; the confidence interval(95%CI)\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pelvic fracture, Humeral fracture, Risk factors, Age, Injury severity score, Tile type","lastPublishedDoi":"10.21203/rs.3.rs-1604358/v2","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1604358/v2","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePelvic fractures are often associated with other injuries, and in our study, pelvic fractures associated with humeral fractures were the most common. We pooled patient data to analyze the independent risk factors for pelvic fractures associated with humeral fractures.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective study was conducted on the clinical data of 254 patients with pelvic fractures admitted to the Department of Orthopedics of Chengdu Fifth People\u0026rsquo;s Hospital, from August 2017 to August 2021. Independent sample T test found that pelvic fractures combined with humeral fractures were statistically significant. The main outcome indicators of pelvic fracture combined with humeral fracture were as follows: Tile classification of pelvic fractures, number of humeral fractures and Injury Severity Scale (ISS); Secondary outcome indicators: gender, age, body mass index (BMI), cause of injury, underlying diseases, etc. Single factor analysis was performed to screen risk factors for each indicator, and logistic analysis was used to determine independent risk factors for indicators with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOf the 254 patients with pelvic fractures, 24 (9.45%) were associated with humeral fractures, much higher than other single injuries, and only pelvic fractures associated with humeral fractures were statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.014). Pelvic fractures without concomitant humeral fractures (n\u0026thinsp;=\u0026thinsp;230) and pelvic fractures with concomitant humeral fractures (n\u0026thinsp;=\u0026thinsp;24) were associated with age (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006; 95% CI\u0026thinsp;=\u0026thinsp;0.087\u0026ndash;0.665; OR\u0026thinsp;=\u0026thinsp;10.258), ISS score (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002; 95% CI\u0026thinsp;=\u0026thinsp;1.839\u0026ndash;4.445; OR\u0026thinsp;=\u0026thinsp;8.721), Tile scores (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01; 95% CI\u0026thinsp;=\u0026thinsp;22.554\u0026ndash;87.419; OR\u0026thinsp;=\u0026thinsp;22.736), but there was no statistical significance in gender (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.03), BMI (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.437) and injury cause (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.04).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe combination of pelvic fracture and humerus fracture was statistically significant, and age\u0026thinsp;\u0026gt;\u0026thinsp;60 years old, pelvic fracture Tile B2 classification above and high ISS were the independent risk factors for humerus fracture in pelvic fracture. Therefore, in clinical work, when clinicians treat patients with pelvic fractures aged\u0026thinsp;\u0026gt;\u0026thinsp;60 years old, Tile B2 type above classification of pelvic fractures and high ISS, they should be highly vigilant about whether the humerus fractures are accompanied.\u003c/p\u003e","manuscriptTitle":"Risk factors of pelvic fracture combined with humeral fracture: A retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2022-09-01 20:05:04","doi":"10.21203/rs.3.rs-1604358/v2","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}},{"code":1,"date":"2022-05-06 18:58:03","doi":"10.21203/rs.3.rs-1604358/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8147ad10-bc03-4988-8716-328a42e93511","owner":[],"postedDate":"September 1st, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-09-19T21:44:14+00:00","versionOfRecord":[],"versionCreatedAt":"2022-09-01 20:05:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v2","identity":"rs-1604358","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1604358","identity":"rs-1604358","version":["v2"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}