Sequence of Fixation in Vertically Unstable Tile C1.2 and C1.3 Pelvic Ring Injuries: A Randomized Controlled Trial | ||||
| The Egyptian Orthopaedic Journal | ||||
| Articles in Press, Accepted Manuscript, Available Online from 04 June 2025 | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/eoj.2025.379220.1036 | ||||
 View on SCiNiTO | ||||
| Authors | ||||
Ahmed Mohamed Sallam Masoud  ; Amr Mohamed Nagy; El Zaher Hassan EL Zaher; Karim Atef Abdelghani Yousef; Islam Sayed Mousa
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| Orthopedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt. | ||||
| Abstract | ||||
| Background: Vertically unstable Tile C1.2 and C1.3 pelvic ring injuries present a significant challenge in trauma care. Despite advances in fixation techniques, the optimal sequence of fixation remains undefined. Objective: This study aims to compare anterior-first versus posterior-first fixation in Tile C1.2 and C1.3 pelvic fractures regarding operative time, radiological outcomes, functional recovery, and complication rates. Patients and Methods: In this randomized clinical trial, 60 adult patients with pure ligamentous vertically unstable pelvic injuries (Tile C1.2 and C1.3) were randomized into two equal groups: group A (anterior-first fixation) and group B (posterior-first fixation). All underwent standard open reduction and internal fixation (ORIF) procedures followed by a structured rehabilitation protocol. Outcomes were assessed using operative time, radiological grading, Majeed pelvic scores (MPS), and complication rates over one-year follow-up. Results: The anterior-first group demonstrated significantly shorter operative time (148 ± 18 vs. 162 ± 22 min; P = 0.014), and higher rates of good-to-excellent radiological outcomes (86.7% vs. 60%; P = 0.02). Functional scores were significantly better in group A at 3 months (67 ± 4 vs. 65 ± 3; P = 0.03), 6 months (81 ± 6 vs. 78 ± 5; P = 0.029), and 1 year (92 ± 7 vs. 85 ± 6; P < 0.001). Multivariate regression confirmed anterior-first fixation as an independent predictor of improved outcomes. Conclusions: Anterior-first fixation in vertically unstable pelvic injuries is an effective strategy associated with better radiological and functional outcomes, shorter operative time, and comparable safety profile. | ||||
| Keywords | ||||
| Pelvic Ring Injuries; Tile C1.2; Tile C1.3; Anterior-First Fixation; Posterior-First Fixation | ||||
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