Treatment Strategies for Isolated LC-1 Pelvic Injuries: A Comparative Cohort Study of Percutaneous Posterior-Only vs. Combined Anterior–Posterior Fixation

<b>Background:</b> The management of lateral compression type 1 (LC-1) pelvic fractures remains controversial. Posterior fixation alone has traditionally been practiced without clearly defined indications for supplementary anterior stabilization. Direct comparative evidence between posterior-only and combined anterior-posterior fixation remains scarce. This study evaluated whether institutional criteria reliably identify patients who benefit from additional percutaneous anterior fixation. <b>Methods:</b> A retrospective cohort study was conducted at a level I trauma center and included adults with LC-1 fractures treated exclusively by percutaneous fixation. Combined anterior-posterior fixation was performed when predominant anterior pain and radiographic compromise indicated instability. Primary outcomes were pain trajectory (Numeric Rating Scale), inpatient opioid use, physiotherapy clearance, and ward mobility. <b>Results:</b> Thirty-seven patients were analyzed (combined = 14; posterior-only = 23). Preoperative pain was higher in the combined group (median 7 vs. 6; median difference 1 [95% CI 0 to 2]; <i>p</i> = 0.0036). Postoperatively, pain scores were lower in the combined group at 1-6 weeks (median difference -1 [95% CI -2 to 0]; <i>p</i> < 0.05). Opioid consumption was reduced (193 mg vs. 312 mg; median difference -200 mg [95% CI -280 to -120]; <i>p</i> < 0.001), and physiotherapy clearance occurred earlier (4 vs. 7 days; median difference -3 [95% CI -5 to -1]; <i>p</i> = 0.020). <b>Conclusion:</b> Our current indications to perform combined fixation were associated with favorable early outcomes in pain control and physiotherapy clearance among patients with LC-1 fractures showing anterior compromise. These results support a selective combined approach, though interpretation must remain cautious given the small retrospective cohort. Further prospective studies are warranted to validate these findings and refine patient selection.