One-year outcomes of spinopelvic fixation in unstable pelvic trauma patients: A prospective cohort study

Spinopelvic injuries represent some of the most complex challenges in orthopedic trauma, with profound implications for patient function and quality of life. This study aimed to evaluate the comprehensive one-year clinical, functional, and radiographic outcomes of spinopelvic fixation in a cohort of patients with unstable pelvic trauma. A prospective cohort study was conducted at two university-affiliated trauma centers. Between March 2023 and March 2024, 54 consecutive adult patients with traumatic spinopelvic instability who underwent surgical fixation were enrolled, with 45 completing the one-year follow-up (follow-up rate: 83.3%).Primary outcomes included the Majeed Pelvic Score (MPS). Secondary outcomes encompassed pain severity (Visual Analogue Scale, VAS), functional independence (SF-36 Physical Functioning subscale, Barthel Index), radiographic parameters (vertical pelvic displacement, leg length discrepancy), and surgery-related complications. Assessments were performed preoperatively and at 2 weeks, 1, 3, 6, and 12 months postoperatively. The mean patient age was 41.9 ± 13.5 years, with 73.3% male. The most common injury patterns were AO/OTA 61-C type injuries (62.2%) and Denis Zone II sacral fractures (48.9%). A significant and sustained improvement was observed in the MPS, increasing from 35.0 ± 8.2 at two weeks to 84.0 ± 7.1 at one year (p<0.001). Pain scores demonstrated a significant reduction over time (p<0.001). However, at the 12-month follow-up, chronic pain (defined as VAS >4 for ≥2 consecutive months after postoperative month 3) was present in 35.6% (n=16) of patients. Functional scores (SF-36 PF, Barthel Index) showed marked improvement (p<0.001). Radiographically, mean vertical pelvic displacement decreased from 14.2 ± 4.1 mm preoperatively to 3.8 ± 1.9 mm postoperatively (mean difference 10.4 mm; 95% CI 9.2–11.6, p<0.001), and leg length discrepancy was significantly reduced from 31.0 ± 12.0 mm to 9.0 ± 1.0 mm (p<0.001). The overall complication rate was 20%, including surgical site infection (8.9%), implant failure (4.4%), and neurologic injury (4.4%). In carefully selected trauma patients with unstable pelvic injuries, spinopelvic fixation facilitates significant improvement in pelvic function, pain reduction, functional independence, and anatomical restoration at one-year follow-up. While the complication rate is notable, most complications were manageable. The high prevalence of chronic pain at one year highlights an area requiring targeted multidisciplinary intervention. Therapeutic Level IV.