{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T11:03:49Z","timestamp":1794654229840,"version":"4.9.1"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","funder":[{"DOI":"10.13039\/100001473","name":"AO North America","doi-asserted-by":"crossref","award":["Fellows Research Grant"],"award-info":[{"award-number":["Fellows Research Grant"]}],"id":[{"id":"10.13039\/100001473","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6]]},"abstract":"\n OBJECTIVE:<\/jats:title>\n To determine whether anterior internal or definitive external fixation combined with posterior internal fixation of unstable pelvic fractures was associated with frequency of discharge to home.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Two Level 1 trauma centers and one academic tertiary referral center.<\/jats:p>\n <\/jats:sec>\n \n Patient Selection Criteria:<\/jats:title>\n Patients aged 16 years or older with unstable OTA\/AO 61B\/C pelvis fractures treated with operative fixation of the anterior and posterior pelvic ring by three fellowship-trained orthopaedic trauma surgeons from October 2020 to November 2022.<\/jats:p>\n <\/jats:sec>\n \n Outcome Measures and Comparisons:<\/jats:title>\n The primary outcome was the adjusted odds of discharge to home with internal fixation compared with definitive external fixation of the anterior pelvic ring on multivariable analysis considering patient, injury, and treatment characteristics. Secondary outcomes included bivariable associations between anterior fixation type and intensive care unit (ICU) days, ventilator days, hospital length of stay, and hospital charges.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n Seventy-nine patients (65%) who were treated with internal fixation presented with higher mean Glasgow Coma Scale scores (13.5 \u00b1 3.6 vs. 10.5 \u00b1 5.4, P<\/jats:italic> < 0.01) than 43 patients treated with definitive external fixation but were otherwise similar regarding age [mean 48.1 \u00b1 19.9 vs. 41.2 \u00b1 15.8, range (16\u201396) versus (19\u201377), P<\/jats:italic> = 0.07], sex (36.7% vs. 44.2% female, P<\/jats:italic> = 0.42193), mean body mass index (28.4 \u00b1 6.2 vs. 28.7 \u00b1 7.4 kg\/m2<\/jats:sup>, P<\/jats:italic> = 0.93), any medical comorbidities (50.6% vs. 44.2%, P<\/jats:italic> = 0.62), substance use (13.9% vs. 27.9%, P<\/jats:italic> = 0.09884), insurance type (P<\/jats:italic> = 0.97), mean Injury Severity Score (24.8 \u00b1 12.0 vs. 29.5 \u00b1 14.0, range 5\u201357 vs. 10\u201357, P<\/jats:italic> = 0.14), pelvis fracture pattern (P<\/jats:italic> = 0.12187), and preinjury living environment (P<\/jats:italic> = 0.67695). On multivariable analysis, patients treated with internal fixation were more frequently discharged to home (53.2% vs. 27.9%, odds ratio 3.39, 95% confidence interval 1.29\u20139.84, P<\/jats:italic> = 0.0198). Patients treated with anterior internal fixation also experienced fewer mean ICU days (6.0 \u00b1 8.8 vs. 9.8 \u00b1 16.3, P<\/jats:italic> = 0.0213), ventilator days (3.5 \u00b1 8.2 vs. 6.9 \u00b1 15.9, P<\/jats:italic> < 0.0081), and hospital days (18.7 \u00b1 16.2 vs. 31.2 \u00b1 26.7, P<\/jats:italic> < 0.01) and incurred less hospital charges ($278,563.29\u00b1$261,602.35 vs. $580,625.98\u00b1$503,067.98, P<\/jats:italic> < 0.01).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Patients who received anterior and posterior internal fixation of their unstable pelvis fractures were more likely to discharge to home than patients treated with anterior definitive external fixation and posterior internal fixation. Anterior internal fixation was also associated with fewer ICU, ventilator, and hospital days, as well as less hospital charges.<\/jats:p>\n <\/jats:sec>\n \n LEVEL OF EVIDENCE:<\/jats:title>\n Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/bot.0000000000002971","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T14:00:31Z","timestamp":1740492031000},"page":"296-301","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Internal Versus External Fixation of the Anterior Ring in Unstable Pelvic Fractures Was Associated With Discharge to Home"],"prefix":"10.1097","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7494-7366","authenticated-orcid":false,"given":"Joseph T.","family":"Patterson","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6634-7651","authenticated-orcid":false,"given":"Ian G.","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Queen's University Medical Group, Honolulu, HI;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5297-1832","authenticated-orcid":false,"given":"Brandan","family":"Sakka","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7159-1782","authenticated-orcid":false,"given":"Andrew P.","family":"Collins","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, WA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soroush","family":"Shabani","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Duong","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8565-430X","authenticated-orcid":false,"given":"Li","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, CA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7041-9518","authenticated-orcid":false,"given":"Monica D.","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0221-2408","authenticated-orcid":false,"given":"Reza","family":"Firoozabadi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Sports Medicine, University of Washington, Seattle, WA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6326-2468","authenticated-orcid":false,"given":"Joshua L.","family":"Gary","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250516","first-page":"875","article-title":"Prevalence of pelvic fractures, associated injuries, and mortality: the United Kingdom perspective","volume":"63","author":"Giannoudis","year":"2007","journal-title":"J Trauma"},{"key":"R2-20250516","doi-asserted-by":"crossref","first-page":"2834","DOI":"10.3390\/jcm11102834","article-title":"Pelvic fractures-an underestimated problem? 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