Minimally invasive stabilisation of anterior pelvic ring injuries through anterior infix versus percutaneous anterior retrograde pubic screw: a prospective comparative cohort study

BACKGROUND: Management of unstable anterior pelvic ring fractures has shifted toward minimally invasive fixation techniques. This prospective randomized cohort study compares anterior subcutaneous internal fixator with percutaneous retrograde pubic ramus screw fixation, evaluating radiological outcomes, functional scores, complications, and peri-operative parameters. METHODS: Fifty adult patients with unstable anterior pelvic ring injuries (Tile B & C; Young-Burgess lateral compression and vertical shear mechanisms) were enrolled between 2023 and 2025 and randomized into two equal groups: group 1 (internal fixator) and group 2 (retrograde pubic screw). Both groups underwent individualized posterior ring fixation as required. Outcomes assessed included operative time, blood loss, fluoroscopy time, union rate, Matta radiological score at 6 months, Majeed and Pelvic Outcome Scores at 12 months, and post-operative complications. RESULTS: Management of anterior pelvic injury showed that retrograde screw fixation demonstrated significantly shorter operative time (32.0 ± 9.2 vs. 50.3 ± 8.4 min, p < 0.001) and less intraoperative blood loss (68.3 ± 16.2 vs. 122.3 ± 31.8 ml, p < 0.001). Radiological outcomes were comparable: excellent Matta score in 68% vs. 64% (p = 0.834). Union time showed no significant difference (14.1 ± 2.4 vs. 15.1 ± 1.5 weeks, p = 0.076). Functional outcomes at 12 months showed no significant difference in Majeed score (p = 0.517), while Pelvic Outcome Score favored the retrograde screw group (32.3 ± 3.5 vs. 30.0 ± 3.3, p = 0.023). Internal fixator had a higher rate of lateral femoral cutaneous nerve injury (28%), while retrograde screw fixation showed fewer reoperations and lower implant removal rate. CONCLUSION: Upon reviewing study cases and relevant literature, both minimally invasive techniques can provide reliable fixation and comparable radiological and functional outcomes for unstable anterior pelvic ring fractures. Retrograde pubic ramus screw fixation offers advantages of reduced blood loss and lower neurovascular complications. Internal fixator offers slightly reduced fluoroscopy exposure but carries a higher risk of lateral femoral cutaneous nerve irritation. LEVEL OF EVIDENCE: Level 4.