Learning curve analysis of the anterior intrapelvic approach for pelvic ring and acetabular fractures during implementation in a trauma center.

PURPOSE: The anterior intrapelvic approach (AIP) is increasingly used for pelvic ring and acetabular fractures, yet its learning curve during structured implementation remains poorly defined. This study evaluated the learning curve associated with AIP introduction in a trauma center.

METHODS

A retrospective analysis of a prospectively maintained database was conducted at a level-1 trauma center. Eighty-six consecutive patients treated with AIP by a single senior surgeon (2015-2019) were included. Patients were divided chronologically into two equal groups (first 43 vs. last 43 cases). The primary outcome was operative time. Secondary outcomes included blood loss, reduction quality assessed on postoperative CT (Matta and Matta-Tornetta criteria), and complications. Multivariable analyses were performed to identify independent predictors of operative time and reduction quality.

RESULTS

Operative time decreased significantly from 226 ± 93 to 187 ± 83 min (p = 0.04) and remained independently associated with case sequence (p < 0.01). Blood loss decreased by 31% (897 ± 694 vs. 620 ± 436 mL, p = 0.01). Reduction quality remained stable, with anatomical or satisfactory reduction achieved in 86% of cases, without intergroup differences. The overall complication rate was 8%. Early postoperative neurological deficits were more frequent in the initial phase but decreased significantly over time (p = 0.04). No implant failures or loss of reduction were observed.

CONCLUSION

AIP implementation was associated with improved operative efficiency without compromising reduction quality or increasing complications, suggesting a progressive learning curve with an acceptable and improving neurological morbidity profile in a trauma center setting.