Hoskins Wayne, Gusho Charles, Haase Douglas, Milby Josh, Crist Brett, Della Rocca Gregory J, Schweser Kyle, Stannard James P, Parola Rown, Bravin Daniel
Department of Orthopaedic Surgery, University of Missouri, Columbia, MO USA.
Department of Orthopaedic Surgery, University of Missouri, Columbia, MO USA.
Injury. 2025 Jun;56(6):112320. doi: 10.1016/j.injury.2025.112320. Epub 2025 Apr 1.
To compare outcomes of lateral compression LC2 and LC3 pelvic ring injuries when posterior ring fixation is applied and different anterior ring constructs are used.
A retrospective analysis from two Academic Level I Trauma Centers of all operatively treated LC2 and LC3 (AO/OTA 61-B2/B3) pelvic ring injuries from January 2019-January 2024. A comparison of anterior ring constructs was made: no fixation vs. fixation; indirect fixation (external fixators and InFix)) vs. internal fixation; long vs. short percutaneous screws. Long percutaneous screws were defined as either bicortical bypassing all 3 Nakatani zones or bypassing the fracture by 2 Nakatani zones with intramedullary juxtacortical or bicortical finishing. A short screw was defined as all other screws, regardless of direction. Primary outcome measure was >1 cm of pelvic ring displacement from post-operative to final radiographs showing fracture healing with sufficient callus. Secondary outcomes were unplanned major reoperation, removal of implants or non-union repair, and other surgical complications.
67 patients met inclusion criteria. Most were female (n = 35, 52 %), mean age was 48.3 (SD 21.7) and most injuries were LC3 (n = 39, 58 %). All cases had posterior ring fixation. Twelve (18 %) had no anterior ring fixation and there was a statistically higher rate of deformity compared with patients with anterior ring fixation (n = 55, 82 %) (58 % vs. 16 %, p = 0.005). Indirect fixation (n = 12, 18 %) had a statistically higher rate of deformity compared with internal fixation (n = 43, 64 %) (50 % vs. 7 %, p = 0.002). There was a statistically higher rate of deformity when a short percutaneous screw (n = 6, 9 %) rather than long screw was used (n = 26, 39 %) (50 % vs. 0 %, p = 0.004).
Routine anterior ring fixation in conjunction with posterior ring fixation is strongly encouraged for LC2 and LC3 injuries. A long percutaneously-applied anterior screw provides optimal stability to maintain reduction and prevent deformity.
Therapeutic Level 3.
