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

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. 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. 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%. 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.