Comparative Efficacy of Retrograde Pubic Ramus Intramedullary Nails and Percutaneous Cannulated Screws in Treating Anterior Pelvic Ring Fractures: A Retrospective Cohort Study.

Objective: To compare the clinical outcomes of retrograde pubic ramus intramedullary nail (RPRIN) and percutaneous cannulated screw (PCS) in the treatment of anterior pelvic ring fractures (APRFs).

Methods: This retrospective cohort study included 45 patients with APRFs treated between February 2019 and October 2022 in our trauma center. Patients were divided into two groups based on the surgical method: 20 received RPRIN fixation, and 25 received PCS fixation. Key variables including operation time, fluoroscopic time, blood loss, and postoperative complications were analyzed. Fracture reduction quality was assessed using the Matta score system, and pelvic functional recovery was evaluated using the Majeed score system at the final follow-up. Quantitative variables were compared using the independent sample t test, while categorical variables were analyzed using Chi-square and Fisher's exact tests.

Results: The RPRIN group had significantly shorter operation time (36.3 ± 5.6 min vs. 49.5 ± 6.9 min, P < 0.01), fluoroscopic time (32.0 ± 2.8 s vs. 48.4 ± 3.6 s, P < 0.01), and less blood loss (20.4 ± 7.6 mL vs. 34.0 ± 5.7 mL, P < 0.01) than the PCS group. Fracture reduction quality (Matta outcome) and pelvic functional recovery (Majeed outcome) were comparable between the two groups (P > 0.05). No significant complications were reported in either group.

Conclusions: Both RPRIN and PCS are effective for treating APRFs. However, RPRIN offers distinct advantages by reducing operation time, fluoroscopic time, and blood loss, making it a more efficient and less invasive option. Further multicenter studies and biomechanical analyses are warranted to confirm these findings.