Anterior and posterior fixation versus posterior fixation only of minimally displaced lateral compression type 1 pelvic ring injuries: A multicenter propensity-matched analysis.

Abstract

The ideal fixation construct for treatment of stress-positive lateral compression type 1 (LC1) pelvic ring injuries is controversial. The purpose of this study was determine if anterior and posterior fixation (AF+PF) versus posterior fixation only (PF) of patients with LC1 pelvic ring injuries is associated with home discharge. A multicenter retrospective review was performed at eight level one trauma centers of adult patients with stress-positive minimally displaced LC1 pelvic ring injuries (OTA/AO 61B) treated with AF+PF versus PF. Outcomes included length of stay, maximum feet ambulated with physical therapy (PT) while hospitalized, discharge disposition, independent ambulation at last follow-up, and mortality. AF+PF versus PF patients were compared in terms of age, sex, Charleston Comorbidity Index (CCI), injury mechanism, and Beckman score. Propensity-matching was used to control for group differences. There were 434 patients included; 64.5% (n = 280) treated with AF+PF and 35.5% (n = 154) with PF. Patients treated with AF+PF, versus PF, were older (47.0 vs. 38.0 years; p = 0.01), had a higher CCI (0 vs 0; p = 0.02), a higher Beckman score (8.0 vs. 7.0; p = 0.04), more low-energy falls (18.6% vs. 8.4%; p = 0.004), less independent ambulators (92.1% vs 97.4%; p = 0.03), and more rami fractures with 100% displacement (26.8% vs. 12.3%; p = 0.0004). The groups did not differ in gender, complete sacral fractures, days to surgery, or follow-up duration (p > 0.05). Propensity-matching resulted in two groups of 141 patients, similar in age, CCI, Beckman score, low-energy falls, 100% rami fracture displacement, and follow-up duration (p > 0.05). On matched analysis, patients treated with AF+PF, versus PF, spent fewer days in the hospital (7.0 vs. 8.0; p = 0.03) and were more likely to discharge home (76.6% vs. 63.1%; p = 0.0005). There was no observed difference between groups in terms of feet ambulated with PT, independent ambulation at last follow-up, or mortality (p > 0.05). Matched patients with stress-positive minimally displaced LC1 injuries treated with AF+PF compared to PF spent fewer days in the hospital and were more likely to discharge home. Therapeutic Level III.