Vertically Unstable Pelvic Ring Injuries: Impact of Multilevel and Transsacral Fixation Strategy on Failure Rate

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Pelvic fracture management

Background:

• Vertically unstable pelvic ring injuries present complex treatment challenges.
• Percutaneous pelvic fixation is a common surgical approach.
• Identifying optimal fixation strategies is crucial for successful outcomes.

Purpose of the Study:

• To evaluate outcomes of percutaneous pelvic fixation for displaced vertically unstable pelvic ring injuries.
• To identify fixation constructs that predict treatment success.
• To compare Multilevel sacral fixation and Transsacral fixation (MAT) versus Single-level or SI screw-only fixation (SS).

Main Methods:

• Retrospective cohort study at a Level I trauma center.
• Included 67 patients with OTA/AO 61C.1-3 injuries treated with SI or TS screws.
• Compared MAT fixation (N=38) versus SS fixation (N=29).

Main Results:

• MAT fixation demonstrated a significantly lower treatment failure rate (2.6%) compared to SS fixation (48.3%, P<0.001).
• Revision surgery rates were significantly lower with MAT fixation (2.6%) versus SS fixation (31.0%, P=0.002).
• Posterior ring injury patterns included sacral fractures, SI fracture dislocations, and SI dislocations.

Conclusions:

• Multilevel sacral fixation including at least one transsacral screw is associated with significantly lower treatment failure.
• Single-level or SI screw-only fixation showed a substantially higher failure rate.
• Adjunctive fixation strategies should be considered when multilevel transsacral fixation is not feasible.