Immediate weight-bearing for pelvic ring fractures: A case-control study based on a retrospective monocentric series of 163 patients

INTRODUCTION: Although the incidence of pelvic ring injuries is increasing, particularly among older patients, there is no clear consensus regarding the resumption of weight-bearing after surgical treatment. This study aimed to evaluate the indications for, and outcomes of, immediate weight-bearing following surgery for pelvic ring fractures in a Level I trauma center. HYPOTHESIS: We hypothesized that immediate weight-bearing following surgical fixation of pelvic ring fractures is safe and does not adversely affect functional or radiological outcomes compared with restricted weight-bearing. METHODS: This retrospective, single-center, case-control study included 70 patients from a cohort of 163 patients surgically treated for a pelvic ring fracture between January 2020 and December 2022. Patients were allocated to two groups based on postoperative weight-bearing status after propensity score analysis and 1:1 nearest-neighbor matching. Demographic characteristics, fracture patterns, functional outcomes (Majeed score, return to work and sports), radiological outcomes, and complications were assessed and compared. RESULTS: Immediate weight-bearing was permitted in older patients (mean age 59 vs 50 years, p = 0.043), predominantly female (24/46, 52.2% vs 29/117, 24.8%, p < 0.001), with a lower Injury Severity Score (16.5 vs 22, p < 0.001), and more frequently presenting with AO B2 lesions (rotationally unstable, vertically stable; 35/46, 76.1% vs 55/117, 47%, p < 0.001). After matching for sex, age, fracture classification, Injury Severity Score, BMI, and comorbidities, two groups of 35 patients each were compared. Following immediate weight-bearing, functional outcomes were superior, with a higher mean Majeed score (92 vs 84, p = 0.006), higher rates of return to sport at same level (18/27, 67% vs 12/28, 43%, p = 0.041). No significant differences were observed in complications such as fixation failures or nonunion rates. CONCLUSION: Immediate weight-bearing in selected patients following pelvic ring fracture fixation appears feasible without compromising functional recovery or radiological outcomes. The statistical power to detect hardware failure or pseudarthrosis is insufficient, and the results should therefore be interpreted with caution. High-level evidence studies are needed to develop early mobilization protocols that can improve and standardize clinical practice. LEVEL OF EVIDENCE: III; case-control study.