ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2026
Surgical management of severely displaced IPRF: operative technique, indications, and preliminary clinical outcomes.
Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundStandardized surgical protocols for severely displaced inferior pubic ramus fractures (IPRF) remain scarcely reported. This study presents the operative technique and preliminary clinical outcomes of open reduction and internal fixation (ORIF) via the trans-inferior pubic ramus approach.
methodsThis retrospective case series included 6 patients with severely displaced IPRF (fracture separation ≥ 1.5 cm) treated with ORIF between 2016 and 2022. Fractures were categorized using a 3-zone anatomical system, Type I/II morphological typing, and conventional Tile/AO classifications to guide implant selection. Fracture union was confirmed by pelvic radiographs and CT, and functional outcomes were assessed using the 1-year Majeed Pelvic Score (MPS).
resultsThe cohort comprised 4 males and 2 females (mean age 48.3 ± 13.4 years; mean follow-up 15.5 ± 3.2 months). Five fractures involved Zones II and III, and one extended across all three zones; 4 were Type I simple fractures and 2 Type II comminuted fractures, including 3 Tile/AO A2.2 and 3 Tile B injuries. Mean fracture displacement was 3.1 ± 0.9 cm. Mean operative time was 48.3 ± 17.2 min, with a mean intraoperative blood loss of 53.3 ± 25.0 mL; half of the patients underwent second-stage supplementary fixation. All fractures achieved bony union within 3-6 months. Five patients had excellent MPS (100 points), and one had fair function (65 points). No major perioperative complications occurred.
conclusionSeverely displaced IPRF requiring surgery is rare, accounting for the small 6-case sample. The trans-inferior pubic ramus approach achieves low perioperative morbidity, reliable union, and satisfactory short-term function for operatively indicated cases. The 1.5 cm displacement threshold serves as an exploratory reference and requires prospective validation. All conclusions are limited by the small sample and warrant verification in large multicenter studies.
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