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. 2024 Oct;34(7):3535-3541.
doi: 10.1007/s00590-023-03681-0. Epub 2023 Sep 24.

Union and displacement characteristics following percutaneous screw fixation of superior pubic rami fractures

Christopher D Flanagan  1 , Ryan Fairchild  1 , Meghan McCaskey  1 , Mir Ibrahim Sajid  1 , David Watson  1 , Hassan Mir  2
Affiliations

Union and displacement characteristics following percutaneous screw fixation of superior pubic rami fractures

Christopher D Flanagan et al. Eur J Orthop Surg Traumatol. 2024 Oct.

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.

Keywords: Complications; Lateral compression pelvic ring injuries; Percutaneous superior ramus fixation; Union and displacement metrics.

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References

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