• H Schmal, L Froberg, S LarsenMMDepartment of Orthopaedics and Traumatology, Odense University Hospital, Odense, Denmark and Department of Clinical Research, University of Southern Denmark, Odense, Denmark., N P Südkamp, T Pohlemann, E Aghayev, and K Goodwin Burri.
• Department of Orthopaedics and Traumatology, Odense University Hospital, and Department of Clinical Research, University of Southern Denmark, Odense, Denmark and Department of Orthopaedics and Trauma Surgery, Medical Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
• Bone Joint J. 2018 Jul 1; 100-B (7): 973-983.

AimsThe best method of treating unstable pelvic fractures that involve the obturator ring is still a matter for debate. This study compared three methods of treatment: nonoperative, isolated posterior fixation and combined anteroposterior stabilization.Patients And MethodsThe study used data from the German Pelvic Trauma Registry and compared patients undergoing conservative management (n = 2394), surgical treatment (n = 1345) and transpubic surgery, including posterior stabilization (n = 730) with isolated posterior osteosynthesis (n = 405) in non-complex Type B and C fractures that only involved the obturator ring anteriorly. Calculated odds ratios were adjusted for potential confounders. Outcome criteria were intraoperative and general short-term complications, the incidence of nerve injuries, and mortality.ResultsOperative stabilization reduced mortality by 36% (odds ratio (OR) 0.64, 95% confidence interval (CI) 0.42 to 0.98) but the incidence of complications was twice as high (OR 2.04, 95% CI 1.57 to 2.64). Mortality and the incidence of neurological deficits at discharge were no different after isolated posterior or combined anteroposterior fixation. However, the odds of both surgical (98%, OR 1.98, 95%CI 1.22 to 3.22) and general complications (43%, OR 1.43, 95% CI 1.02 to 2.00) were higher in the group with the more extensive surgery.ConclusionOperative stabilization is recommended for non-complex unstable pelvic fractures. The need for anterior fixation of obturator ring fractures should, however, be considered critically. Cite this article: Bone Joint J 2018;100-B:973-83.

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