Posterior ilioileal pedicle screw fixation alone versus anterior and posterior pelvic ring fixation in type 2 anteroposterior compression pelvis ring injuries: A retrospective comparative study

Objectives: Type II anteroposterior compression (APC) pelvic ring injuries (PRIs) are typically managed with combined anterior and posterior fixation, though this approach can increase operative time, blood loss, and recovery delay. Posterior ilioiliac fixation offers a less invasive alternative. This study compares its clinical and radiological outcomes with those of combined fixation in APC type II injuries. Methods: This retrospective comparative study included 80 adult cases with type II APC PRIs. Cases were classified into two equal groups: Group A received posterior-only fixation, while Group B underwent combined fixation. Outcomes assessed included operative time, intraoperative blood loss, time to weight-bearing, postoperative pain (as measured by the visual analog scale [VAS]), symphyseal gap, fixation failure, infection, and functional outcome (as measured by the Majeed score). Results: The posterior-only group showed significantly shorter operative times (40 ± 4 vs. 93 ± 8 min, P < 0.001) and lower blood loss (89 ± 19 vs. 187 ± 38 mL, P < 0.001). Early weight-bearing was more frequent (85% vs. 55%, P = 0.003), and 1-month VAS scores were lower (Median 1 vs. 2, P = 0.001). However, the combined group demonstrated a smaller 6-month symphyseal gap (Median, 1 cm vs. 2 cm; P = 0.011). Other outcomes, including fixation failure and infection rates, were comparable. Conclusion: Posterior ilioiliac fixation alone offers an effective, safe, and minimally invasive alternative to combined fixation in selected APC type II PRIs, with favorable perioperative and early functional outcomes.