Combined Anterior–Posterior versus Posterior-Only Fixation of Stress-Positive Minimally Displaced Lateral Compression Type 1 (LC1) Pelvic Ring Injuries

Objectives: To compare hospital outcomes and late displacement between stress-positive minimally displaced lateral compression type 1 (LC1) pelvic ring injuries treated with combined anterior–posterior versus posterior-only fixation. Design: Retrospective comparative cohort. Setting: Urban level-one trauma center. Patients/Participants: LC1 injuries managed operatively. Intervention: Anterior–posterior versus posterior-only fixation; Main Outcome Measurements: Physical therapy (PT) clearance, discharge location, hospital length of stay (LOS), inpatient morphine equivalent doses (MED), and fracture displacement at follow-up. Results: Groups were similar in demographic and injury characteristics (age, high energy mechanism, ASA score, stress displacement, and rami/sacral fracture classifications). Anterior–posterior fixation resulted in longer operative times (median difference (MD): 27.0 minutes, 95% confidence interval (CI): 17.0 to 40.0, P < 0.0001) and had a trend of increased estimated blood loss (MD: 10 mL, CI: 0 to 30, P = 0.07). Patients with anterior–posterior fixation required less inpatient MEDs (MD: −180.0, CI: −341.2 to −15.0, P = 0.02), were more likely to clear PT by discharge (100% vs. 70%, proportional difference (PD): 30%, CI: 2.0%–57.2%, P = 0.02), were less likely to discharge to rehabilitation facilities (0% vs. 30%, PD: 30%, CI: 2.0%–57.2%, P = 0.02), and had a trend of less days to clear PT after surgery (MD: −1, CI: −2 to 0, P = 0.09) and decreased LOS (MD: −1, CI: −4 to 1, P = 0.17). Late fracture displacement did not differ between groups. Conclusion: Anterior–posterior fixation of LC1 injuries was associated with an improved early hospital course—specifically, reduced inpatient opioid use and an increased number of patients who could clear PT and discharge home. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.