BackgroundFailure of fixation (FF) in pubic symphysis diastasis (SD) ranges between 12 to 75%, though whether it influences functional outcomes is still debated. The objective of this study is to evaluate the impact of anterior pelvic plate failure and loss of reduction on Majeed`s functional scores. MethodsSingle center retrospective review of consecutive patients with acute SD treated by means of anterior pubic plating. Thirty seven patients with a mean age 45.7+/-14.4 years, were included. Demographics, AO classification, pelvic fixation and secondary procedures were recorded. Majeed´s functional scores at minimum 6 months followup were compared according to the presence of FF and loss of reduction. ResultsFifteen patients presented FF. Eight presented an additional loss of symphyseal reduction. Mean Majeed´s score (MMS) in patients with and without FF was 64,4+/-13,04 and 81.8+/-15.65 respectively (p=0.0012). Differences in MMS in patients without FF and those with FF and maintained or loss of anterior reduction were 11,3 [70,5vs81,8] (p=0,092) and 22.7 [59,1vs81,8] (p=0,001) respectively. Significant association of FF with AO classification was noted. (OR 12.6; p=0.002).ConclusionsDifferences in MMS in the analysed groups suggest that loss of reduction might be more relevant than failure of the anterior osteosynthesis in functional outcomes.