[Other] Surgical complications after fixation of minimally displaced lateral compression type 1 pelvic ring injuries Copy

Purpose: To review surgical complications after fixation of stress-positive minimally displaced (< 1 cm) lateral compression type 1 (LC1) pelvic ring injuries.

Methods: A retrospective study at a level one trauma center identified patients who received surgical fixation of isolated LC1 pelvic ring injuries. Surgical complications and additional procedures were reviewed.

Results: Sixty patients were included. The median age was 61 years (Interquartile range 40-70), 65% (n = 39) were women, and 57% (n = 34) had high-energy mechanisms. Anterior-posterior, posterior-only, and anterior-only fixation constructs were used in 77% (n = 46), 15% (n = 9), and 8% (n = 5) of patients. Anterior fixation was performed with rami screw fixation in 82% (49/60), external fixation in 2% (1/60), and open reduction and plate fixation in 2% (1/60). There were 15 surgical complications in 23% (14/60), and 12 additional procedures in 17% (10/60). Complications included loss of reduction ≥ 1 cm (8%), symptomatic hematomas (8%), symptomatic backout of unicortical retrograde rami screws (5%), deep infection of the pelvic space after a retrograde rami screw (1.6%), and iatrogenic L5 nerve injury (1.6%). All losses of reduction involved geriatric females with distal rami fractures sustained in ground-level falls. Loss of reduction was found to be more likely in patients with low energy mechanisms (proportional difference (PD) 62%, 95% confidence interval (CI) 18% to 76%; p = 0.01) and 2 versus 1 posterior pelvic screws (PD 36%; CI 0.4% to 75%; p = 0.03).

Conclusions: Surgical complications and additional procedures routinely occurred after fixation of LC1 injuries. Patients should be appropriately counseled on the risks of surgical fixation of these controversial injuries.

Level of evidence: Diagnostic, Level III.

Keywords: Bleeding; Complications; Lateral compression type 1 pelvic ring injury; Lateral stress radiograph; Operative fixation; Percutaneous screw fixation; Reoperation; Retrograde rami screws; Stress exam.