Early Outcomes of Operative Versus Nonoperative Management of Stress-Positive Minimally Displaced Lateral Compression Type 1 Pelvic Ring Injuries

Abstract

Objectives: To compare the early outcomes of patients with stress-positive minimally displaced lateral compression type 1 (LC1b) pelvic ring injuries managed with or without operative fixation. Design: Retrospective comparison study. Setting: Level 1 trauma center. Patients/Participants: Forty-three patients with LC1b injuries. Intervention: Operative versus nonoperative. Main Outcome Measurements: Discharge to subacute rehabilitation (SAR); 2- and 6-week pain visual analog score, opioid use, assistive device use, percentage of normal single assessment numerical evaluation, SAR status; fracture displacement; and complications. Results: The operative group did not differ in age, gender, body mass index, high-energy mechanism, dynamic displacement stress radiographs, complete sacral fractures, Denis sacral fracture classification, Nakatani rami fracture classification, follow-up length, or American Society of Anesthesiologists classification. The operative group was less likely to be using an assistive device at 6 weeks [observed difference (OD) −53.9%, 95% confidence interval (CI) −74.3% to −20.6%, OD/CI 1.00, P = 0.0005], less likely to remain in an SAR at 2 weeks (OD −27.5%, CI, −50.0% to −2.7%, OD/CI 0.58, P = 0.02), and had less fracture displacement at follow-up radiographs (OD −5.0 mm, CI, −9.2 to −1.0 mm, OD/CI 0.61, P = 0.02). There were no other differences in outcomes between treatment groups. Complications occurred in 29.6% (n = 8/27) of the operative group compared with 25.0% (n = 4/16) of the nonoperative group resulting in 7 and 1 additional procedures, respectively. Conclusions: Operative treatment was associated with early benefits over nonoperative management, including shorter time using assistive devices, less SAR use, and less fracture displacement at follow-up. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.