Abstract
Purpose
To determine union and displacement metrics following percutaneous screw fixation (antegrade or retrograde) of superior pubic rami fractures.
Methods
This is a retrospective cohort study from a single level 1 trauma center. Skeletally mature patients with at least one superior pubic ramus fracture present as part of a lateral compression-type pelvic ring injury were included.
Results
Eighty-five (85) patients with 95 superior pubic rami fractures met the study’s inclusion criteria. LC1, LC2, and LC3 injuries occurred in 76.5%, 15.3%, and 8.2% of patients, respectively. The majority of patients underwent concurrent posterior pelvic ring fixation (94.1%). Superior ramus screw placement occurred predominantly via retrograde technique (81.1%) with cannulated screws of size 6.5 mm or larger (93.7%). Of the 95 eligible fractures, 90 (94.7%) achieved union at a mean of 14.0 weeks (7–40 weeks). Of these united fractures, 69 (76.7%) healed with no measurable displacement, while the remaining 23.3% healed with residual mean displacement of 3.9 mm (range: 0.5–9.0 mm). Multivariable analysis demonstrated a positive association between age (p = 0.04) and initial displacement (p = 0.04) on the final degree of residual displacement at union. A Kaplan–Meier survival analysis identified increased age to be significantly related to increased time to union (X2 (2) = 21.034, p < 0.001).
Conclusions
Union rates following percutaneous screw fixation of superior pubic rami fractures associated with lateral compression-type pelvic ring injuries approach 95%. Though minimal in an absolute sense, increasing age and a greater degree of initial displacement may influence the final degree of residual displacement at union.
Level of evidence
IV.
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Availability of data and materials
The data were available through the FOI and TGH databases.
Code availability
Not applicable.
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HM helped in conception of study, F, MM collected the data, MIS, HM were involved in analysis, CF, MIS drafted the work, DW, CF contributed to revisions, HM finally approved the study.
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Flanagan, C.D., Fairchild, R., McCaskey, M. et al. Union and displacement characteristics following percutaneous screw fixation of superior pubic rami fractures. Eur J Orthop Surg Traumatol (2023). https://doi.org/10.1007/s00590-023-03681-0
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DOI: https://doi.org/10.1007/s00590-023-03681-0