ArticleInternational orthopaedics2026
Anterior-posterior versus posterior-only stabilization of unstable pelvic ring injuries in polytraumatized patients: a comparative analysis of clinical, radiological, and long-term functional outcomes.
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Abstract
backgroundPelvic ring fractures (PRF) in polytraumatized patients can have a substantial impact on both short- and long-term outcomes. This study aimed to compare the outcomes of combined anterior-posterior (AP) stabilization versus posterior-only (PO) fixation for unstable PRFs in polytraumatized patients.
methodsThis retrospective, cross-sectional cohort study included adult polytraumatized patients with AO/OTA type B and C pelvic ring injuries treated at a Level I trauma centre between 2010 and 2023. Patients were assigned to one of two groups according to the definitive pelvic stabilization strategy: posterior-only (PO) fixation or combined anterior-posterior (AP) stabilization. The primary outcomes were functional recovery and quality of life, assessed using the Pelvic Outcome Score and the EuroQol EQ-5D-5L. Secondary outcomes included complication rates, quality of radiographic fracture reduction, time to mobilization, length of hospital stay, and pain at discharge.
resultsA total of 158 patients were included in the study; most were male (n = 102, 64.6%), with a median age of 42 years. Fifty-eight patients (36.7%) completed the cross-sectional follow-up assessment after a median follow-up of four years. Overall, 31.0% (n = 49) underwent definitive posterior-only (PO) stabilization, whereas 69.0% (n = 109) underwent combined anterior-posterior (AP) stabilization according to the institutional treatment protocol. AO/OTA type C injuries were significantly more common in the AP group. No significant differences were observed between the AP and PO groups with respect to length of hospital stay, complication rates, time to mobilization, functional outcomes, or quality of life. AP stabilization was associated with superior radiographic fracture reduction, particularly of the anterior pelvic ring, but this did not translate into improved long-term outcomes. PO fixation was associated with lower pain scores at follow-up (median VAS, 2 vs. 4; p < 0.05), particularly among patients with AO/OTA type B injuries.
conclusionsBoth AP and PO stabilization, when selected according to the institutional treatment protocol, yielded comparable functional outcomes and complication rates in polytraumatized patients with unstable pelvic ring fractures. The choice of stabilization strategy should be individualized based on pelvic injury morphology, patient physiology, and overall trauma burden within the framework of Early Appropriate Care principles. Further prospective studies are needed to validate these findings and identify factors influencing long-term recovery.
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