Internal vs external fixation of the anterior ring in unstable pelvic fractures was associated with discharge to home.

Objective: To determine if anterior internal or definitive external fixation combined with posterior internal fixation of unstable pelvic fractures was associated with frequency of discharge to home.

Methods: Design: Retrospective cohort study.

Setting: Two Level 1 Trauma Centers and one academic tertiary referral center.

Patient selection criteria: Patients aged ≥16 years with unstable OTA/AO 61B/C pelvis fractures treated with operative fixation of the anterior and posterior pelvic ring by three fellowship-trained orthopaedic trauma surgeons from October 2020 to November 2022.

Outcome measures and comparisons: The primary outcome was the adjusted odds of discharge to home with internal fixation compared with definitive external fixation of the anterior pelvic ring on multivariable analysis considering patient, injury, and treatment characteristics. Secondary outcomes included bivariable associations between anterior fixation type and intensive care unit (ICU) days, ventilator days, hospital length of stay, and hospital charges.

Results: Seventy-nine patients (65%) who were treated with internal fixation presented with higher mean Glasgow Coma Scale scores (13.5±3.6 vs 10.5±5.4, p<0.01) than 43 patients treated with definitive external fixation, but were otherwise similar to with regard to age (mean 48.1±19.9 vs 41.2±15.8, range (16-96) vs (19-77), p=0.07), sex (36.7% vs 44.2% female, p=0.42193), mean, body mass index (28.4±6.2 vs 28.7±7.4 kg/m2, p=0.93), any medical comorbidities (50.6% vs 44.2%, p=0.62), substance use ((13.9% vs 27.9%, p=0.09884), insurance type (p=0.97), mean Injury Severity Score (24.8±12.0 vs 29.5±14.0, range 5-57 vs 10-57, p=0.14), pelvis fracture pattern (p=0.12187), and preinjury living environment(p=0.67695). On multivariable analysis, patients treated with internal fixation were more frequently discharged to home (53.2% vs 27.9%, odds ratio 3.39, 95% confidence interval 1.29-9.84, p=0.0198). Patients treated with anterior internal fixation also experienced fewer mean ICU days (6.0±8.8 vs 9.8±16.3, p=0.0213), ventilator days (3.5±8.2 vs 6.9±15.9, p<0.0081), and hospital days (18.7±16.2 vs 31.2±26.7, p<0.01); and incurred less hospital charges ($278,563.29±$261,602.35 vs $580,625.98±$503,067.98, p<0.01).

Conclusions: Patients who received anterior and posterior internal fixation of their unstable pelvis fractures were more likely to discharge to home than patients treated with anterior definitive external fixation and posterior internal fixation. Anterior internal fixation was also associated with fewer ICU, ventilator, and hospital days, as well as less hospital charges.

Level of evidence: Therapeutic Level III.