Anterior-First Approach to Unstable Pelvic Ring Fracture Fixation: Functional Outcomes and the Importance of Anatomic Reduction

Authors

  • Reza Zarei Assistant Professor, Department of Orthopedic Surgery and Traumatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Alireza Manafi Rasi Professor, Department of Orthopedic Surgery and Traumatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Mojtaba Baroutkoub Assistant Professor, Department of Orthopedic Surgery and Traumatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Mahdi Ghasemi Nik Resident, Department of Orthopedic Surgery and Traumatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Seyed Shahab Aldin Vaziri Researcher, Department of Orthopedic Surgery and Traumatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Ali Pourmojarab Assistant Professor, Department of Orthopedic Surgery and Traumatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

DOI:

https://doi.org/10.18502/jost.v12i4.22582

Keywords:

Fracture Fixation; Treatment Outcome; Retrospective Studies; Pelvic Bones

Abstract

Background: Unstable pelvic ring fractures are high-energy injuries with complex anatomy and significant morbidity. Surgical fixation is the standard treatment; however, there is still controversy over the optimal sequence of anterior and posterior stabilization. An anterior-first fixation may help stabilize the pelvis, facilitate posterior reduction, and improve functional outcomes.

Methods: We retrospectively reviewed patients with unstable pelvic ring injuries using a standardized “anterior-first” fixation protocol. Radiographic reduction was assessed using Matta and Tornetta criteria on anteroposterior (AP), inlet, and outlet views. Functional outcomes at a minimum of 12 months were measured using the Iowa Pelvic Score (IPS) and Majeed Pelvic Score (MPS). Clinical complications, including bleeding requiring transfusion, hematuria, and limb-length discrepancy (LLD), were recorded.

Results: The study included 20 patients with a mean age of 40.7 ± 16.3 years. Excellent or good reductions were achieved in most patients, with 45% and 60% of cases rated as “Excellent” on the AP and inlet views, respectively. Outlet views showed greater variability, with 40% fair reduction. Mean IPS and MPS scores were 84.2 ± 16.7 and 78.9 ± 16.0, respectively, and were strongly correlated with each other (r = 0.82, P < 0.001). Older patients (> 50 years) achieved functional outcomes comparable to younger cohorts. Clinically, bleeding requiring transfusion occurred in 45%, hematuria in 35%, and LLD > 1 cm in 35%. No catastrophic complications were observed.

Conclusion: In this small retrospective case series, anterior-first fixation was associated with acceptable radiographic reduction and favorable functional outcomes in selected patients with unstable pelvic ring injuries. Given the limited sample size and the absence of a comparator group, these findings should be interpreted with caution. Larger prospective comparative studies are needed to clarify the optimal fixation sequence.

Published

2026-09-12

Issue

Volume (12) issue (4)

Section

Articles