Percutaneous anterior pelvic ring fixation in addition to percutaneous posterior pelvic ring fixation decreases postoperative pain and narcotic usage in hospital for LC1 and LC2 injuries

Objectives: To compare postoperative pain and opioid requirements between LC1 and LC2 injuries treated with anterior and posterior fixation (AF+PF) vs. posterior fixation (PF) only. Methods: Design : Retrospective review of propensity matched cohorts for sex, age, LC1 vs. LC2, sacral fracture type, and preoperative visual analogue scores (VAS) were created in a 1:1 ratio. Setting: Level 1 Trauma Center and Academic Tertiary Care Hospital Patient Selection Criteria: Adult patients with LC1 or LC2 (OTA/AO 61B2.1, 61B2.2) injuries treated surgically with PF or AF+PF between March 2019 through January 2024. Outcome Measures and Comparisons: VAS and morphine milligram equivalents (MMEs) were measured at 24 and 48 hours postoperatively, and 24 hours before discharge between the groups. Secondary outcomes included postoperative days to mobilization (DTM) and length of stay (LOS). Results: 56 patients (28 AF+PF, mean age 49.4+16.9, 57.1% female, 28 PF, mean age 49.8+16.9, 53.6% female) were included. There were no differences between the groups for demographic data (all p > 0.78). AF+PF patients had lower VAS scores than PF patients 24 hours postoperatively (Difference in Mean (DIM): 2.18 cm (95%-confidence interval (95-CI): 0.9068 -3.4532), p=0.001), 48 hours postoperatively (DIM: 3.43 cm (95-CI: 2.11 to 4.75), p<0.001), and 24 hours before discharge (DIM: 2.68 (95%-CI: 1.31 to 4.04), p<0.001). AF+PF patients required lower MMEs 24 hours before discharge (DIM: 6.989 (95%-CI: 0.873 to 13.105), p=0.026). AF+PF patients also had shorter DTM (DIM: 3.21 (95-CI: 0.03 to 6.40), p=0.048). There were no differences in MMEs 24 hours postoperatively (DIM: 3.64 (95%-CI: -4.15 to 11.44), p=0.35), 48 hours postoperatively (DIM: 4.78 (9%-5CI: -3.12 to 12.67), p=0.23), or LOS (DIM: 1.96 (95%-CI: -2.03 to 5.95), p=0.33). Conclusions: Anterior and posterior fixation was associated with significantly decreased inpatient postoperative pain, pre-discharge narcotics use, and days to mobilization compared to posterior fixation alone. The combination of percutaneous anterior and posterior fixation for LC1 and LC2 pelvic ring injuries should be considered when the goals are maximizing pain control.