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    2. Deutscher Kongress für Orthopädie und Unfallchirurgie 2026 (DKOU 2026)
    3. Is anterior ring fixation necessary in fragility fractures of the pelvis?
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German Congress of Orthopaedics and Traumatology 2026 (DKOU 2026)

Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU), Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC), Deutsche Gesellschaft für Unfallchirurgie (DGU), Berufsverband für Orthopädie und Unfallchirurgie (BVOU)
20.-23.10.2026
Berlin

Meeting Abstract

Is anterior ring fixation necessary in fragility fractures of the pelvis?

Jan Gewiess - Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Schweiz
Spyridon Karampitianis - Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Schweiz
Johannes Dominik Bastian - Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Schweiz
Moritz Deml - Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Schweiz
Fabienne Pohle - Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Schweiz
Christian Tinner - Department of Orthopedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Schweiz

Text

Objectives and questions: In fragility fractures of the pelvis minimally invasive posterior stabilisation is commonly performed, whereas the indication for additional anterior pelvic ring fixation remains controversial. This study compares posterior-only versus combined anterior–posterior stabilization in FFP to evaluate differences in reoperation rates, perioperative burden, and radiographic results.

Study question: Does additional anterior pelvic ring fixation, compared with posterior-only stabilization, reduce reoperation rates or improve radiologic outcomes in fragility fractures of the pelvis, and what is its impact on perioperative burden?

Material and methods: A retrospective study was conducted at a single Level 1 trauma center including patients treated surgically for fragility fractures of the pelvis involving both the anterior and posterior pelvic ring between 2013 and 2024. Group 1 underwent combined anterior and posterior pelvic ring fixation, while Group 2 received posterior-only fixation. Perioperative parameters included blood loss, operative time, and length of hospital stay. Radiographic outcomes assessing anterior fracture stability, rotational stability, pelvic symmetry, and vertical displacement were evaluated preoperatively, postoperatively, at 6 weeks, and at final follow-up.

Results: Fifty-five patients were included (31 in Group 1, 24 in Group 2). Mean age was 80 years, and demographic characteristics did not differ between groups. Posterior-only fixation showed a trend toward a lower reoperation rate compared with combined fixation (4% vs. 16%, p = 0.166). Perioperative burden was significantly reduced in the posterior-only group, with lower blood loss (20 vs. 200 mL, p = 6.20 × 10⁻⁹) and shorter operative time (46 vs. 160 min, p = 5.54 × 10⁻⁸). Radiographic parameters—including normalized fracture gap, inlet/outlet/AP ratios, deformity indices, and vertical measurements—were comparable between groups at all postoperative time points, with only isolated minor differences in normalized fracture gap.

Discussion and conclusions: Posterior-only fixation of fragility fractures of the pelvis is associated with a significantly lower perioperative burden and comparable radiologic outcomes to combined anterior–posterior stabilization, without an increased rate of reoperation. These findings do not support routine fixation of the anterior pelvic ring when adequate posterior stabilization is achieved.