Posterior-only versus combined anterior-posterior stabilization in fragility fractures of the pelvis: Reoperations, perioperative burden, and radiographic outcomes.

Abstract

Fragility fractures of the pelvis (FFP) are increasingly encountered in older adults, but the value of additional anterior ring fixation in surgically treated fractures involving both the anterior and posterior pelvic ring remains uncertain. We compared posterior-only with combined anterior-posterior stabilization in FFP. In this retrospective single-center cohort study, we included patients aged ≥ 65 years who underwent operative stabilization of FFP between 2013 and 2024. Eligible patients had osteoporosis- or low-energy-related fractures with preoperative computed tomography confirmation of combined anterior and posterior pelvic ring involvement. Patients underwent combined anterior-posterior stabilization (group 1, n = 31) or posterior-only stabilization (group 2, n = 24). The primary outcome was reoperation within 2 years. Secondary outcomes were blood loss, operative time, and length of stay. Radiographic outcomes were analyzed longitudinally with linear mixed-effects models. Posterior-only fixation was not associated with a higher reoperation rate; reoperation occurred in 1/24 patients (4%) in group 2 and 5/31 (16%) in group 1 (odds ratio, 0.23; 95% confidence interval, 0.03-2.02; p = 0.216). Posterior-only stabilization was associated with substantially lower blood loss (median, 20 vs 200 mL; p < 0.0001) and shorter operative time (46 vs 160 min; p < 0.0001), with a nonsignificant trend toward shorter hospital stay (6.5 vs 10 days; p = 0.0615). Across radiographic follow-up, no consistent postoperative differences were observed in fracture gap, pelvic symmetry, or vertical alignment. Exploratory subgroup analysis restricted to FFP types 3 and 4 yielded similar findings. Among older adults undergoing surgery for FFP involving both pelvic rings, posterior-only stabilization was associated with lower perioperative burden and similar radiographic evolution, without evidence of increased reoperation. These findings do not support routine addition of anterior fixation.