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Selective Anterior Fixation for Rami Fractures in Anteroposterior Compression-Type Pelvic Ring Injuries: Impact of
Jeong-Hyun Koh1, Sumin Lim1, Won-Tae Cho1
1Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon 16499, Republic of Korea.
Journal of Clinical Medicine
|May 27, 2026
Summary
Posterior ring injury, not direct rami fixation, predicts complications in anteroposterior compression pelvic fractures. Adding rami fixation to symphyseal plating increased operative time without significant benefit in this study.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Pelvic Reconstruction
Background:
- Anteroposterior compression (APC)-type pelvic ring injuries with rami fractures often heal well conservatively.
- The role of direct rami fixation when posterior instability is present remains uncertain.
Purpose of the Study:
- To evaluate if adding direct rami fixation to symphyseal plating improves outcomes in APC-type pelvic ring injuries.
- To identify predictors of complications in these injuries.
Main Methods:
- Retrospective cohort study of 98 patients with APC type II or III pelvic ring injuries and pubic rami fractures.
- Patients underwent symphyseal plating, with fixation strategies categorized into four groups.
- Primary outcomes included rami nonunion and implant-related complications, analyzed via multivariate logistic regression.
Main Results:
- Complete posterior ring injury independently predicted rami nonunion, implant-related complications, and overall complications.
- Female sex was an independent predictor of overall complications.
- Direct rami fixation did not significantly reduce complications but increased operative time; subgroup analyses were underpowered.
Conclusions:
- Complete posterior ring injury is the primary predictor of adverse outcomes in APC pelvic ring injuries.
- Adding direct rami fixation to symphyseal plating did not show statistically significant benefits in this exploratory, underpowered analysis.
- Direct rami fixation may be reserved for specific complex cases; further prospective research is needed.
