Comparison of One-Year Functional Outcomes and Quality of Life between Posterior Pelvic Ring Fixation and Combined Anterior-Posterior Pelvic Ring Fixation after Lateral Compression (B2 Type) Pelvic Fracture

Abstract

Background and Objectives: The treatment algorithm of lateral compression B2 type pelvic fractures are still under debate. Some authors advocate conservative treatment, while others recommend surgical approach. The clear indications for isolated anterior or posterior ring fixation or combined anterior-posterior pelvic ring fixation of B2 type fractures remain unclear. The aim of this study was to compare the functional outcomes and quality of life after isolated posterior pelvic ring fixation and combined anterior-posterior pelvic ring fixation for the treatment of B2 pelvic fractures. Materials and Methods: Patients aged 18 to 65 years with B2 type pelvic fracture hospitalized in a single trauma centre over a period of 3 years were included in the research. Based on the attending surgeon’s preference, patients were treated with isolated posterior or combined anterior-posterior pelvic fixation. The quality of life and pelvic function were assessed using SF-36 and Majeed questionnaires, respectively. Patients filled in the questionnaires twice: during the first hospitalization (concerning their pre-trauma state—timepoint I) and one-year after the injury (timepoint II). Results: A cohort of 32 patients with B2 type pelvic fracture was enrolled in the analysis: 23 (72%) were female and 9 (28%) were male. The mean age was 35.3 ± 11.9 years. In this cohort 13 (41%) patients underwent isolated posterior pelvic ring fixation (group I) and 19 (59%) patients underwent combined anterior-posterior pelvic ring fixation (group II). No statistically significant differences were observed between the groups in both timepoints concerning Majeed, SF-36 PCS and MCS scores. However, in both groups Majeed and SF-36 PCS scores were statistically significantly lower one year after pelvic fracture compared with pre-trauma state, while SF-36 MCS scores did not differ. Conclusions: No differences were found in quality of life and functional outcomes between isolated posterior pelvic ring fixation and combined anterior-posterior fixation for the treatment of B2 type pelvic fractures.

Combined Anterior–Posterior versus Posterior-Only Fixation of Stress-Positive Minimally Displaced Lateral Compression Type 1 (LC1) Pelvic Ring Injuries

“…Similar to the present study, Petryla et al 37 compared posterior-only with combined anterior–posterior fixation for all OTA/AO 61-B2 pelvic fractures, focusing primarily on function and quality of life at 1 year follow-up. Although they found no significant differences in patient-reported outcome measures between groups at one year, they did not evaluate the hospital course or early recovery process, which is when differences in outcomes would be most likely be present.…”

Anterior Pelvic Ring Fracture Pattern Predicts Subsequent Displacement in Lateral Compression Sacral Fractures

“…The controversy surrounding LC pelvic fractures is not limited to nonoperative management. There is a growing movement of surgeons advocating for posterior-only transsacral/iliosacral fixation for many B-type pelvic ring injuries, 18,19 even though the concept of placing fixation at the fulcrum, or point of rotation, does not inherently make biomechanical sense. The results of this study demonstrate that posterior fixation alone does not provide adequate stability to prevent subsequent displacement in pelvic fracture patterns with the unstable anterior injuries noted herein (comminuted and/or oblique superior and inferior pubic rami fractures) (Table 3).…”

Bony Sacral Volume after Sacro-Iliac Screw Fixation of Pelvic Fractures Is Dependent on Reduction of the Anterior Pelvic Ring

“…However, there is ongoing discussion about posttraumatic pelvic deformity caused by sacral hyper-compression in SSF of pelvic fractures [ 10 , 18 , 19 ]. There is a number of studies investigating anterior stabilization in combined anterior and posterior pelvic fractures [ 9 , 12 , 16 , 20 , 21 , 22 ]. Combined stabilization is associated with longer operative time, an increased blood-loss and a longer hospital stay [ 12 , 13 , 23 ].…”