A validated CT-based scoring system for lateral compression type one pelvic ring injuries provides insight into the spectrum of injury severity and guides treatment decisions; a prospective study.

Abstract

To gain insight into the spectrum of injury severity in lateral compression type 1 (LC1) pelvic ring injuries using a validated CT-based scoring system and to determine how injury severity relates to treatment and clinical outcomes. A prospective study was performed in 203 patients presenting with LC1 injuries at a level one trauma center. CT-scans were assessed using a CT-based scoring system that quantifies injury severity on a scale of 5–14. Patients were categorized into three injury severity groups: low (scores 5–6), intermediate (scores 7–9), and high (scores 10–14) subgroups based on level of sacral displacement, Denis classification, sacral column involvement, inferior ramus displacement, and superior ramus fracture location. Clinical outcomes included delayed intervention due to mal- of non-union, Dutch Short Musculoskeletal Function Assessment and EuroQol-5D 5L at one-year follow-up. Normative data was used to determine recovery. All patients with low scores (n = 36), 94% of intermediate scores (n = 99), and 71% of high scores (n = 44) were treated conservatively. No conservatively treated patients required delayed intervention. In all subgroups, most recovered to the level of the normative data, with no significant differences in outcomes between operatively and conservatively treated patients. The LC1 CT-based scoring system provides insight into the spectrum of injury severity and helps guide treatment decisions for LC1 injuries. Patients with low and intermediate injury severity, determined by degree of sacral and pubic rami involvement, can be treated nonoperatively. Those with high injury severity can be treated either conservatively or operatively. The online version contains supplementary material available at 10.1007/s00590-025-04619-4.