gms | German Medical Science

German Congress of Orthopaedics and Traumatology (DKOU 2019)

22. - 25.10.2019, Berlin

Management of LC type I (LC-1) pelvic injuries with complete sacral fracture in developing settings: is there a role for solitary anterior fixation?

Meeting Abstract

  • presenting/speaker Pengfei Wang - Xi'an Honghui Hospital, Xi'an, China
  • Yan Zhuang - Xi'an Honghui Hospital, Xi'an, China
  • Binfei Zhang - Xi'an Honghui Hospital, Xi'an, China
  • Kun Zhang - Xi'an Honghui Hospital, Xi'an, China
  • Yuxuan Cong - Xi'an Honghui Hospital, Xi'an, China
  • Hu Wang - Xi'an Honghui Hospital, Xi'an, China

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocIN46-980

doi: 10.3205/19dkou726, urn:nbn:de:0183-19dkou7265

Published: October 22, 2019

© 2019 Wang et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objectives: Management of LC-1 type pelvic injuries,particularly in patients with complete sacral fracture (LC-1 PICSF, OTA type 61-B2.1), remains controversial. Treatment algorithms additionally differ between developed and developing countries; operative fixation remains commonplace in the latter, despite research suggesting a role for non-operative management. In these settings, less-invasive solitary anterior fixation is a growing alternative to traditional combined anterior-posterior fixation for treatment of mild-to-moderate severity LC-1 PICSFs. However, specific indications for solitary fixation remain unclear, and there is a paucity of outcomes data in comparison to combined fixation. We undertook a prospective study in patients with LC-1 PICSFs to compare outcomes between solitary anterior fixation and combined anteriorposterior fixation.

Methods: A prospective cohort study was conducted from 2014 to 2015 at a single tertiary-referral center in China. Adults with operatively managed LC-1 PICSFs were enrolled. Patients with sacral displacement <1 cm as assessed by axial CT received solitary anterior ring fixation (Group A); patients with displacement more than 1 cm received combined fixation of both the anterior and posterior rings (Group B). Reduction was confirmed by manipulation under anesthesia. Patients followed up for at least 24 months post-operatively. Outcomes included intraoperative characteristics, pain (VAS score), quality of fracture reduction (Tornetta and Matta radiographic grading), rate of union, functional outcome (Majeed score), weight-bearing status, and complication rate.

Results: 68 (89%) of 76 enrolled patients completed the minimum 2-year follow-up.Patients undergoing solitary anterior fixation (Group A) exhibited improved operative times, less time under fluoroscopy, and less blood loss as compared to combined anterior-posterior fixation (Group B). There were no significant differences between Groups A and B regarding quality of fracture reduction, rate of union, functional outcomes, or rate of complications. Notably, Group B patients were more likely to achieve full weight-bearing status at final follow-up.

Conclusion: Patients treated with solitary anterior fixation demonstrated comparable outcomes and improved operative characteristics over those treated with combined anterior-posterior fixation. These differences highlight the potential of solitary anterior fixation as a less-invasive treatment alternative for LC-1 PICSFs with sacral displacement <1 cm, particularly in developing settings where operative fixation remains commonplace.