Unstable Pelvic ring fractures managed surgically: A 13-year cohort study of patient characteristics, associated injuries, and predictors of early mortality

Background and purpose Unstable pelvic ring fractures are severe injuries with substantial mortality and a high burden of associated injuries. Advances in trauma care have improved outcomes. However, recent data from high-volume centers remain scarce. We aimed to evaluate mortality, associated injuries, and predictors of mortality in surgically treated unstable pelvic ring fractures. Methods We retrospectively analyzed 451 consecutive patients with surgically treated Tile B or C pelvic ring fractures admitted to a Level 1 trauma center between 2008 and 2021. Patient demographics, injury characteristics, and associated injuries were recorded. Kaplan–Meier methods were used to estimate survival, and Cox regression for identifying independent predictors of mortality. Results Overall mortality at 3-month was 4.2% (95% CI 2.3–6.0) and at 1-year at 6.0% (95% CI 3.8–8.2). Tile C fractures had a higher early mortality than Tile B (3-month: 6.5% vs. 2.1%; 1-year: 7.4% vs. 4.7%). Associated injuries were common: 78% of patients had at least one and 66% had two or more injured regions. Patients with injuries in ≥2 regions had markedly higher intensive care unit (ICU) admission, transfusion requirements, and early mortality. In multivariable Cox regression, age (HR 1.06 per year), Glascow Coma Scale (GCS) ≤8 (HR 4.9), and Tile C (HR 3.6) were independently associated with 90-day mortality. Conclusion Mortality after surgically treated unstable pelvic ring fractures at 3- month and 1 year was 4.2% and 6.0%, respectively. Age, low GCS, and Tile C fracture pattern were independent predictors of early death. Associated injuries and overall trauma burden were strongly associated with ICU admission, transfusion, and early mortality.