Surgical management of severely displaced IPRF: operative technique, indications, and preliminary clinical outcomes

Standardized 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.

This 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).

The 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.

Severely 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.