Minimally invasive internal fixation versus symphyseal screws for unstable pelvic ring fractures

Stabilization of the anterior pelvic ring is crucial in the management of unstable pelvic ring fractures. Minimally invasive internal fixation (INFIX) has been proposed as an alternative to conventional symphyseal plate fixation; however, comparative clinical evidence remains limited.

To compare INFIX and percutaneous symphyseal screws fixation for unstable pelvic ring fractures in terms of perioperative parameters, complications, radiological outcomes, and functional results.

This retrospective comparative study included 50 patients with unstable pelvic ring fractures (APC II-III and LC II-III). Patients were allocated into two groups: INFIX fixation (n = 25) and symphyseal screw fixation (n = 25). Outcomes assessed included union time, operative details, blood loss, fluoroscopic exposure, postoperative complications, pain (Visual Analogue Scale), and functional outcome (Majeed score). Patients were followed for up to 12 months.

Union time was slightly shorter in the screws group (43.7 ± 1.2 vs. 44.9 ± 1.8 days; p = 0.008). Intra-operative blood loss and incision length were significantly higher in the INFIX group (p < 0.001), whereas fluoroscopic exposure was significantly greater in the percutaneous symphyseal screws group (p < 0.001). Postoperative complications were more frequent in the INFIX group (44% vs. 4%; p = 0.001), predominantly implant-related discomfort. Both groups demonstrated significant postoperative pain reduction (p < 0.001), with comparable functional outcomes.

Both fixation techniques effectively achieved fracture union and pain relief. percutaneous symphyseal screws fixation was associated with lower perioperative morbidity and fewer complications, while INFIX required less fluoroscopic guidance. Fixation choice should be individualized based on patient and fracture characteristics.