A comparison of anterior ring fixation constructs in Young-Burgess lateral compression type 2 and 3 (LC2, LC3; AO/OTA 61-B2/B3) pelvic ring injuries: does fixation matter?

OBJECTIVE

To compare outcomes of lateral compression LC2 and LC3 pelvic ring injuries when posterior ring fixation is applied and different anterior ring constructs are used.

METHODS

A retrospective analysis from two Academic Level I Trauma Centers of all operatively treated LC2 and LC3 (AO/OTA 61-B2/B3) pelvic ring injuries from January 2019-January 2024. A comparison of anterior ring constructs was made: no fixation vs. fixation; indirect fixation (external fixators and InFix)) vs. internal fixation; long vs. short percutaneous screws. Long percutaneous screws were defined as either bicortical bypassing all 3 Nakatani zones or bypassing the fracture by 2 Nakatani zones with intramedullary juxtacortical or bicortical finishing. A short screw was defined as all other screws, regardless of direction. Primary outcome measure was >1 cm of pelvic ring displacement from post-operative to final radiographs showing fracture healing with sufficient callus. Secondary outcomes were unplanned major reoperation, removal of implants or non-union repair, and other surgical complications.

RESULTS

67 patients met inclusion criteria. Most were female (n = 35, 52 %), mean age was 48.3 (SD 21.7) and most injuries were LC3 (n = 39, 58 %). All cases had posterior ring fixation. Twelve (18 %) had no anterior ring fixation and there was a statistically higher rate of deformity compared with patients with anterior ring fixation (n = 55, 82 %) (58 % vs. 16 %, p = 0.005). Indirect fixation (n = 12, 18 %) had a statistically higher rate of deformity compared with internal fixation (n = 43, 64 %) (50 % vs. 7 %, p = 0.002). There was a statistically higher rate of deformity when a short percutaneous screw (n = 6, 9 %) rather than long screw was used (n = 26, 39 %) (50 % vs. 0 %, p = 0.004).

CONCLUSIONS

Routine anterior ring fixation in conjunction with posterior ring fixation is strongly encouraged for LC2 and LC3 injuries. A long percutaneously-applied anterior screw provides optimal stability to maintain reduction and prevent deformity.

LEVEL OF EVIDENCE: Therapeutic Level 3.