Luther Lauren, Maxson Ridge, Ponce R Brandon, Morris Cade A, Moreno-Diaz Andres F, Mitchell Phillip M
Vanderbilt University Medical Center, Nashville, USA.
University of Oklahoma Medical Center, Oklahoma City, USA.
Eur J Orthop Surg Traumatol. 2025 Mar 27;35(1):135. doi: 10.1007/s00590-025-04263-y.
Achieving anatomic reduction in combined injuries of the pelvic ring and acetabulum is critical to optimizing outcome. One of the most common combined patterns is a transverse-type acetabular fracture with associated ipsilateral sacroiliac joint instability. The optimal order of fixation (pelvis-first versus acetabulum-first) in these patients remains unclear. The present study aimed to analyze the impact of operative sequence on outcomes when treating transverse variant acetabulum fractures with concomitant posterior pelvic ring disruption.
Across a 12-year period, 24 patients with transverse variant (e.g., transverse, transverse posterior wall, or T-type) acetabulum fractures with unstable cranial segments were identified. This cohort included 17 patients treated with a pelvis-first approach and 7 patients treated with an acetabulum-first approach. Data regarding demographics, mechanism, associated injuries, operative details, post-operative reduction quality, and clinical outcomes were collected.
The average age in this series was 37 years, and 63% of patients were male. All injuries involved a high-energy mechanism, most commonly motor vehicle collision (63%). There were no significant differences in demographic or injury characteristics between cohorts. A pelvis-first approach was associated with a significantly lower rate of poor reduction quality (12% vs. 57%, P = 0.038) and lower blood loss on average (500 mL vs. 1000 mL, P = 0.009) when compared to an acetabulum-first approach.
In this series, a pelvis-first approach was associated with improved reduction quality and decreased blood loss among patients with operatively managed transverse acetabulum fractures with a cranial unstable fracture fragment.
IV.
骨盆环与髋臼联合损伤实现解剖复位对优化治疗效果至关重要。最常见的联合损伤类型之一是横行髋臼骨折合并同侧骶髂关节不稳。此类患者的最佳固定顺序（先骨盆还是先髋臼）仍不明确。本研究旨在分析手术顺序对治疗伴有后方骨盆环断裂的横行变异髋臼骨折疗效的影响。
在12年期间，共纳入24例伴有不稳定头侧骨折块的横行变异（如横行、横断后壁或T型）髋臼骨折患者。该队列包括17例行先骨盆入路治疗的患者和7例行先髋臼入路治疗的患者。收集了患者的人口统计学、损伤机制、合并损伤、手术细节、术后复位质量及临床疗效等数据。
本系列患者的平均年龄为37岁，63%为男性。所有损伤均由高能机制导致，最常见的是机动车碰撞（63%）。两组患者的人口统计学或损伤特征无显著差异。与先髋臼入路相比，先骨盆入路的复位质量差的发生率显著更低（12%对57%，P = 0.038），平均失血量也更低（500 mL对1000 mL，P = 0.009）。
在本系列研究中，对于伴有头侧不稳定骨折块的手术治疗横行髋臼骨折患者，先骨盆入路与更好的复位质量及更少的失血量相关。
IV级。
