Combined pelvic and acetabular injuries: Decision making and clinical results

The impact of reduction sequence on acetabular reduction quality in combined pelvic and acetabular fractures remains unclear. This study aimed to evaluate whether posterior ring reduction first improves acetabular reduction outcomes in these complex injuries.

This retrospective cohort study included adult patients with combined pelvic and acetabular fractures treated at an urban level 1 trauma center between April 2018 and April 2024. Patients with nonoperative acetabular fractures, stable pelvic ring injuries, or nondisplaced acetabular fractures treated percutaneously were excluded. Postoperative CT scans assessed acetabular step-off and gapping. Patients were divided into two groups: the posterior-first group (posterior ring reduced first) and the non-posterior-first group (all other reduction sequences). Demographic data, fracture classification, and surgeon seniority were analyzed for potential confounding effects.

A total of 45 patients were included, with 22 in the posterior-first group and 23 in the non-posterior-first group. The posterior-first group demonstrated significantly higher rates of anatomical reduction for step-off (68.2 % vs 30.4 %, p = 0.017) and gapping (27.3 % vs 4.4 %, p = 0.047). There were no significant differences between groups in demographics, injury mechanism, fracture classification, Injury Severity Score (ISS), or surgeon seniority (p > 0.05). Surgeon seniority did not influence the quality of acetabular reduction (p > 0.05).

Posterior ring reduction first is associated with improved anatomical reduction in acetabular step-off and gapping in combined pelvic and acetabular fractures. These findings support prioritizing posterior ring reduction to optimize acetabular outcomes.