Surgical management and long-term functional outcomes of traumatic pubic symphysis diastasis: a retrospective cohort study

Surgical management of traumatic pubic symphysis diastasis is essential for restoring pelvic stability, yet functional outcomes remain variable. This study aimed to evaluate the functional outcomes and identify predictors of recovery following this intervention at a Level 1 trauma centre in Nepal. A retrospective cohort study was conducted on 69 patients with Anteroposterior Compression (APC) pelvic injuries who underwent surgical stabilization between 2006 and 2020. Data on demographics, injury characteristics, surgical details, and follow-up were collected. The primary outcome was functional status, measured using the Majeed Pelvic Score, dichotomized as favorable (> 85) or unfavorable (≤ 85). Multivariable binary logistic regression was used to identify independent predictors of a favourable outcome. The mean age of participants was 44.1 years, and the majority were male (73.9%). Overall, 72.5% of patients achieved a favourable functional outcome. Multivariable analysis revealed that male sex was a significant negative predictor (OR = 0.043, 95% CI: 0.003–0.567, p = 0.017). Open fractures were also strongly associated with poor recovery (OR = 0.003, 95% CI: 0.000–0.318, p = 0.015). High-energy injury mechanisms, including two-wheeler crashes, four-wheeler collisions, and pedestrian accidents, were linked to higher odds of a good outcome compared with the reference. Paradoxically, patients undergoing combined anterior-posterior fixation had significantly higher odds of achieving favourable functional recovery than those undergoing anterior-only fixation (OR = 27.780, 95% CI: 1.666–463.298, p = 0.021), likely reflecting the greater severity of injuries requiring this approach. While favourable functional outcomes are achievable in most patients with pubic symphysis diastasis, male sex, open fractures, and high-energy injury mechanisms are significant risk factors for poorer recovery. The finding regarding combined fixation likely indicates more severe initial injuries rather than a detrimental treatment effect. These factors should guide patient counselling, surgical planning, and postoperative rehabilitation to optimise results.