{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T19:21:21Z","timestamp":1777404081296,"version":"3.51.4"},"reference-count":25,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: A floating hip injury, defined as an ipsilateral fracture of the pelvis or acetabulum combined with a femoral fracture, represents a rare and devastating musculoskeletal injury resulting from high-energy trauma. Although M\u00fcller type A floating hip injuries comprising an acetabular fracture with an ipsilateral femoral fracture are recognized for their clinical complexity, the long-term prognostic factors influencing functional outcomes remain poorly elucidated. This study aimed to identify independent prognostic factors associated with unsatisfactory long-term functional outcomes in patients with M\u00fcller type A floating hip injuries. Methods: A retrospective study was performed on 68 consecutive patients with M\u00fcller type A floating hip injuries who underwent surgical fixation at a single tertiary trauma center, with a minimum follow-up period of 5 years. Functional outcomes were assessed using the Majeed score, and patients were dichotomized into satisfactory (n = 48; 70.6%) and unsatisfactory (n = 20; 29.4%) outcome groups. Acetabular fractures were classified according to the Judet\u2013Letournel system, and femoral fractures were classified by fracture level (proximal, shaft, or distal). Radiological outcomes were evaluated using Matta\u2019s radiological grading system. Demographic, injury-specific, and treatment-related variables were compared between groups using the Mann\u2013Whitney U test and chi-square test with Bonferroni correction. A multivariate binary logistic regression model was constructed to determine independent predictors of unsatisfactory outcomes. Results: The mean age was 37.15 \u00b1 12.07 years, with a male predominance (67.6%). The predominant mechanism of injury was pedestrian struck by vehicle (54.4%), followed by motor vehicle collision (27.9%) and fall from height (17.6%); collectively, high-energy vehicular trauma accounted for 82.3% of cases. In the univariate analysis, transverse with posterior wall acetabular fracture pattern (p = 0.001), proximal femur fracture level (p = 0.001), associated lower extremity fractures (p = 0.001), nerve damage (p = 0.001), higher body mass index (BMI) (p = 0.001), and lower Matta\u2019s radiological scores (p = 0.001) were significantly associated with unsatisfactory outcomes. Three independent predictors emerged in the multivariate logistic regression: BMI (OR = 1.50; 95% CI: 1.05\u20132.15; p = 0.025), the presence of associated lower extremity fractures (OR = 29.02; 95% CI: 2.83\u2013297.67; p = 0.005), and Matta\u2019s radiological score (OR = 0.06; 95% CI: 0.01\u20130.56; p = 0.014). The model yielded internal discriminatory metrics within the acceptable range (overall accuracy 89.7%, sensitivity 95.8%, specificity 75.0%, Nagelkerke R2 = 0.757); however, given the limited events-per-variable ratio (~6.7) and the wide confidence intervals observed for some predictors, these internal performance estimates are likely optimistic due to potential overfitting, and the findings should be interpreted as exploratory pending external validation. Conclusions: Elevated BMI, the presence of associated ipsilateral lower extremity fractures, and poor quality of acetabular reduction, assessed via Matta\u2019s radiological criteria, are independent determinants of unsatisfactory long-term functional outcomes in M\u00fcller type A floating hip injuries. These findings underscore the critical importance of achieving anatomical reduction in the acetabulum and highlight the compounding effect of additional ipsilateral limb injuries on patient prognosis.<\/jats:p>","DOI":"10.3390\/jcm15093321","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:55:39Z","timestamp":1777370139000},"page":"3321","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Outcome of Patients with a Floating Hip Injury of M\u00fcller Type A: An Analysis of Prognostic Factors Linked to Functional Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1036-6710","authenticated-orcid":false,"given":"Beytullah","family":"Unat","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, School of Medicine, Gaziantep Islam Science and Technology University, Gaziantep 27000, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4942-849X","authenticated-orcid":false,"given":"Cagr\u0131","family":"Karabulut","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, T.C. Ministry of Health Pazarc\u0131k State Hospital, Kahramanmara\u015f 46700, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Musa Alperen","family":"Bilgin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, T.C. Ministry of Health Aksaray Training and Research Hospital, Aksaray 68000, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramazan","family":"Erol","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine, Gaziantep University, Gaziantep 27310, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9349-5286","authenticated-orcid":false,"given":"Ilkan","family":"Kisi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine, Gaziantep University, Gaziantep 27310, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim Halil","family":"R\u0131zvanoglu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Private NCR International Hospital, Gaziantep 27000, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nevzat","family":"G\u00f6nder","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine, Gaziantep University, Gaziantep 27310, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1302\/0301-620X.74B1.1732275","article-title":"The floating hip. Ipsilateral pelvic and femoral fractures","volume":"74","author":"Liebergall","year":"1992","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1007\/s004020050385","article-title":"Ipsilateral fractures of the pelvis and the femur\u2013floating hip? A review of 33 cases","volume":"119","author":"Siebenrock","year":"1999","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_3","first-page":"509","article-title":"Floating injuries: A review of the literature and proposal for a universal classification","volume":"70","author":"Agarwal","year":"2004","journal-title":"Acta Orthop. Belg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1007\/s00590-006-0081-4","article-title":"The floating hip injury: Which should we fix first?","volume":"16","author":"Suzuki","year":"2006","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1097\/00005373-199301000-00014","article-title":"Femoral shaft fractures associated with unstable pelvic fractures","volume":"34","author":"Wu","year":"1993","journal-title":"J. Trauma"},{"key":"ref_6","first-page":"442","article-title":"The floating hip: Complications and outcomes","volume":"64","author":"Burd","year":"2008","journal-title":"J. Trauma"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S75","DOI":"10.1016\/S0020-1383(17)30798-2","article-title":"Floating hip and associated injuries","volume":"48","author":"Cano","year":"2017","journal-title":"Injury"},{"key":"ref_8","first-page":"43","article-title":"Floating hip","volume":"2","author":"Sen","year":"2017","journal-title":"J. Clin. Orthop."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1530\/EOR-23-0013","article-title":"Management of floating hip injury: A review of the literature","volume":"9","author":"Yang","year":"2024","journal-title":"EFORT Open Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/S0020-1383(01)00204-2","article-title":"The floating hip injury: Patterns of injury","volume":"33","author":"Liebergall","year":"2002","journal-title":"Injury"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"401","DOI":"10.52628\/87.3.03","article-title":"Concomitant ipsilateral acetabular and femoral fractures\u2014An appraisal of outcomes and complications in 34 patients","volume":"87","author":"Meena","year":"2021","journal-title":"Acta Orthop. Belg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2309499016684322","DOI":"10.1177\/2309499016684322","article-title":"Functional outcome of patients with unstable pelvic ring fracture","volume":"25","author":"Kokubo","year":"2017","journal-title":"J. Orthop. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1177\/11207000231160075","article-title":"The floating hip injury: A descriptive study and case-control analysis","volume":"34","author":"Wong","year":"2024","journal-title":"Hip Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.2106\/00004623-199611000-00002","article-title":"Fractures of the acetabulum: Accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury","volume":"78","author":"Matta","year":"1996","journal-title":"J. Bone Jt. Surg. Am. Vol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.2106\/00004623-200310000-00002","article-title":"Functional outcomes of acetabular fractures","volume":"85","author":"Moed","year":"2003","journal-title":"J. Bone Jt. Surg. Am. Vol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"27","DOI":"10.55095\/achot2013\/004","article-title":"Transverse + posterior wall fractures of the acetabulum: Epidemiology, operative management and long-term results","volume":"80","author":"Hildebrand","year":"2013","journal-title":"Acta Chir. Orthop. Traumatol. Cech."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/BOT.0000000000002199","article-title":"Complications of Morbid Obesity in the Treatment of Acetabular Fractures: Re-evaluating Outcomes a Decade Later","volume":"36","author":"Robertson","year":"2022","journal-title":"J. Orthop. Trauma."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1302\/0301-620X.71B2.2925751","article-title":"Grading the outcome of pelvic fractures","volume":"71","author":"Majeed","year":"1989","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"311","DOI":"10.55095\/achot2016\/049","article-title":"Floating hip injuries: Treatment outcomes and complications","volume":"83","author":"Pavelka","year":"2016","journal-title":"Acta Chir. Orthop. Traumatol. Cech."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s00590-018-2331-7","article-title":"Short-term follow-up of anterior and posterior both column fractures of acetabulum managed through both column plating","volume":"29","author":"Sharma","year":"2019","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1097\/BOT.0000000000000425","article-title":"Knee Injury Associated with Acetabular Fractures: A Multicenter Study of 1273 Patients","volume":"30","author":"Kempegowda","year":"2016","journal-title":"J. Orthop. Trauma"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2267","DOI":"10.1016\/j.injury.2020.06.016","article-title":"Surgical management of acetabular fractures\u2014A contemporary literature review","volume":"51","author":"Kelly","year":"2020","journal-title":"Injury"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"112965","DOI":"10.1016\/j.injury.2025.112965","article-title":"Association between hip dislocation in pelvic fracture and concomitant knee ligament injuries","volume":"57","author":"Odagiri","year":"2026","journal-title":"Injury"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.rbo.2012.11.002","article-title":"Injury of the knee ligaments associated with ipsilateral femoral shaft fractures","volume":"48","author":"Caldas","year":"2013","journal-title":"Rev. Bras. Ortop."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.2106\/00004623-198264090-00007","article-title":"Injuries to the knee ligaments with fractures of the femur","volume":"64","author":"Walling","year":"1982","journal-title":"J. Bone Jt. Surg. Am. Vol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3321\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T10:29:16Z","timestamp":1777372156000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3321"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,27]]},"references-count":25,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093321"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093321","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,27]]}}}