Posterior-only fixation in pelvic fractures: Is it sufficient in lateral compression injuries?

Purpose: Lateral compression (LC) injuries account for more than two-thirds of all pelvic fractures. The goal of surgical treatment is to provide adequate stability and early mobilization. The consensus on posterior fixation of such injuries is strong in the literature; however, the necessity of anterior ring fixation is not clear. Therefore, this study was formulated to determine the practicability of posterior-only fixation in LC injuries.

Methods: Between March 2015 and May 2020, all patients with LC type pelvic ring fractures who were admitted and operated upon in a single level 1 trauma center were included in this cross-sectional observational study. Demographic data, co-morbidities, treatment, types of surgical fixation, concomitant injuries and surgeries, surgical complications, length of hospital stay, injury to weight bearing duration, and follow-up period were documented. Functional outcome and quality of life were assessed using Majeed score and SF-36 questionnaire. Non-normally distributed data were presented as median (Q₁, Q₃) and normally distributed data were presented as mean ± SD. Spearman's rank correlation coefficient was used for correlation analysis.

Results: A total of 25 patients were included, with a mean age of 29.8 years. All patients were managed operatively with posterior-only fixation. The median Majeed score was 90 (76, 95). The median physical component summary score was 69.37 (38.75, 85.62). The median mental component summary score was 63.95 (39.25, 87.87). There was no significant difference compared to population norms of both physical component summary and mental component summary. Injury to weight bearing time correlated significantly (p = 0.002) with Majeed score as well as SF-36 score (p = 0.044). No other variable had a significant association with outcomes.

Conclusion: Posterior-only fixation is sufficient for fixing LC injuries with up to 80% of cases having good to excellent functional outcomes. However, comparative studies with larger sample sizes are needed for further validation.