Comparison of clinical and radiological outcomes of combined dorsoventral versus isolated dorsal osteosynthetic stabilization of pelvic ring injuries in polytraumatized patients

OBJECTIVES:

To examine the impact of the type of osteosynthetic stabilization on clinical and radiological outcomes in polytraumatized patients with unstable pelvic ring injuries.

METHODS:

This retrospective single-center cohort-study included polytraumatized patients with operatively treated unstable pelvic ring injuries (AO/OTA type B and C) between 2010 and 2023 at an academic level one trauma center. Two cohorts were extracted based on the method of osteosynthetic stabilization: dorsal only (DST) or combined dorsoventral stabilization (VDST). Main outcome measures were in-hospital mortality, quality of fracture reduction, and short-term clinical outcomes as indicated by in-hospital complications and adequacy of re-mobilization.

RESULTS: 158 patients with median age of 42 years were included in this study. All of them were polytraumatized with an ISS ≥ 16 (median=22) and a concomitant unstable pelvic ring injury (AO/OTA type B (n=97) or C (n=61)). All of them were treated surgically by DST (n=49) or VDST (n=109). The rate of pelvic related hemodynamic instability at the time of admission (4,1 vs 30,3%) and prevalence of type C injuries (24,5 vs 45%) were significantly higher in the VDST group (p<0,05). In-hospital mortality (n=13, 8,18%) differed also significantly between groups: all 13 deaths occurred in VDST patients. The reduction extent of the anterior pelvic ring displacement was significantly higher in the VDST group (VDST median=4 mm, DST median=0 mm; p < 0,05), while overall postoperative ventral displacement was still greater in the VDST group (VDST median=5,5 mm vs DST median=2,0 mm; p < 0,05).

CONCLUSIONS: VDST seems to be associated with higher in-hospital mortality. At the same time, VDST significantly improves the postoperative radiological symmetry of the pelvic ring. This should be individually weighted up against the disadvantages of longer and/or multiple surgeries, which may impose a second-hit-burden on the polytraumatized patient.

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