Neglected pelvic ring injuries: prospective evaluation of radiological, functional, and predictive factors for...

Neglected pelvic ring injuries are rare but pose significant reconstructive challenges due to chronic deformity, soft-tissue contracture, and pelvic instability. Evidence on prognostic factors and optimal fixation strategies is limited. This prospective study evaluates radiological and functional outcomes after delayed reconstruction, identifies predictors of reduction quality and complications, and compares minimally invasive INFIX versus open anterior plating.

Twenty patients presenting ≥ 6 weeks post-injury with pelvic malunion or nonunion underwent individualized staged reconstruction between 2019 and 2022. Posterior stabilization was performed first, followed by anterior fixation using either open plating or INFIX. Radiological alignment was graded by Matta's criteria, and functional recovery was assessed with the Majeed Pelvic Score. Correlation and multivariable analyses identified independent predictors of outcomes.

At a mean follow-up of 13.2 months, bone union was achieved in 95% of cases, and anatomical or satisfactory reduction in 90%. Mean Majeed scores improved from 48.7 ± 12.4 to 82.5 ± 9.7 (p < 0.001). Multivariable analysis identified surgical delay > 12 weeks and type C morphology as independent predictors of suboptimal reduction, while minimally invasive INFIX fixation reduced wound complications, providing an evidence-based framework for decision-making. Overall complications occurred in 20% of cases, and the predictive model showed good discriminative power (AUC = 0.81).

Delayed reconstruction of neglected pelvic fractures can achieve high union rates and meaningful functional recovery when guided by meticulous planning, staged fixation, and anatomical reduction. Reduction quality and surgical timing are key determinants of outcome, and INFIX constructs reduce wound complications. Neglected pelvic fractures are uncommon, representing fewer than 5% of all pelvic injuries; despite the small cohort, this study is among the largest prospective series reported, offering novel predictive data to inform timing, technique, and functional expectations in delayed reconstruction.