{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T12:06:57Z","timestamp":1779797217769,"version":"3.53.1"},"reference-count":26,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Acetabular fracture surgery is associated with substantial perioperative blood loss and prolonged operative time. Routine preoperative pelvic computed tomography (CT) carries information about body composition that is not currently exploited for risk stratification. We tested whether (i) CT-defined pelvic sarcopenia is associated with lower preoperative haemoglobin and (ii) preoperative subcutaneous fat cross-sectional area (CSA) is independently associated with operative time, after adjustment for surgical approach, age, fracture complexity and sarcopenia status. Materials and Methods: In this single-centre retrospective cohort study, 48 adults (37 men, 11 women; mean age 40.2 \u00b1 16.5 years) who underwent open reduction and internal fixation (ORIF) for unilateral acetabular fractures between 2016 and 2024 were included. Pelvic muscle and subcutaneous fat CSAs were measured on the contralateral side of preoperative CT images using ImageJ. Sarcopenia was defined as an internal, cohort-relative classification based on the sex-specific bottom tertile of psoas CSA. Normality was assessed by Shapiro\u2013Wilk testing; Pearson or Spearman correlation was used accordingly, and the 36 pairwise correlations were controlled with the Benjamini\u2013Hochberg false-discovery-rate procedure. The multivariable model used ordinary least squares regression with heteroscedasticity-consistent (HC3) standard errors and a median quantile-regression robustness check. Results: Sarcopenic patients (n = 17) had significantly lower preoperative haemoglobin (12.63 \u00b1 1.24 vs. 14.00 \u00b1 1.53 g\/dL; p = 0.002; Cohen\u2019s d = 0.96). The absolute perioperative haemoglobin drop was numerically smaller in the sarcopenic group (\u0394Hb 1.64 \u00b1 0.91 vs. 2.46 \u00b1 1.87 g\/dL) but did not reach statistical significance (p = 0.079); estimated blood loss (p = 0.258) and transfusion requirement (p = 0.567) did not differ between groups. Pelvic muscle CSAs correlated positively with preoperative haemoglobin (all q &lt; 0.05 after Benjamini\u2013Hochberg correction). In the multivariable model (F[6, 41] = 3.71, p = 0.005; adjusted R2 = 0.26; all variance inflation factors 1.06\u20131.26), subcutaneous fat CSA (B = +0.25 min\/cm2, p = 0.004) and the modified Stoppa approach (vs. Kocher\u2013Langenbeck; +65 min, p = 0.001) were independently associated with operative time. Conclusions: In this exploratory retrospective cohort, routine preoperative pelvic CT contained two body-composition signals that may warrant prospective evaluation: pelvic sarcopenia, which was associated with lower baseline haemoglobin, and subcutaneous adiposity, which was associated with longer operative time in the primary regression model. Both signals require confirmation\u2014the sarcopenia\u2013bleeding relationship was not statistically significant, and the subcutaneous fat association was attenuated under robust inference. These findings are hypothesis-generating; prospective multicentre validation with height-normalised sarcopenia thresholds and body mass index is required before clinical implementation.<\/jats:p>","DOI":"10.3390\/medicina62061036","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T11:02:51Z","timestamp":1779793371000},"page":"1036","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative CT-Based Pelvic Sarcopenia and Subcutaneous Adiposity Are Associated with Anaemia and Operative Time in Acetabular Fracture Surgery: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2749-7945","authenticated-orcid":false,"given":"K\u00fcr\u015fat Tu\u011frul","family":"Okur","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Health Sciences University Trabzon Kanuni Training and Research Hospital, 61290 Trabzon, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2153-1030","authenticated-orcid":false,"given":"Ferid","family":"Abdulaliyev","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Yozgat Sorgun State Hospital, 66700 Yozgat, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9210-343X","authenticated-orcid":false,"given":"S\u00fcleyman","family":"Yal\u00e7\u0131n","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, University of Health Sciences, Kayseri City Training and Research Hospital, 38080 Kayseri, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1379-4403","authenticated-orcid":false,"given":"Eda","family":"\u0130\u015ftahl\u0131","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Health Sciences, Kayseri City Training and Research Hospital, 38080 Kayseri, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1061-6169","authenticated-orcid":false,"given":"Mustafa","family":"\u0130\u015ftahl\u0131","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, University of Health Sciences, Kayseri City Training and Research Hospital, 38080 Kayseri, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0296-4914","authenticated-orcid":false,"given":"Ali","family":"Ko\u00e7","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Health Sciences, Kayseri City Training and Research Hospital, 38080 Kayseri, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2417-8343","authenticated-orcid":false,"given":"F\u0131rat","family":"Ozan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, University of Health Sciences, Kayseri City Training and Research Hospital, 38080 Kayseri, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"ref_1","first-page":"e59170","article-title":"Functional Outcomes and Their Influencing Factors for the Surgical Management of T-type Acetabulum Fractures: A Prospective Single-Centre Study of 73 Patients","volume":"16","author":"Kumar","year":"2024","journal-title":"Cureus"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kuwahara, Y., Takemoto, G., Mitsuya, S., and Yamauchi, K.I. (2024). The Long-Term Clinical and Radiographic Outcomes of Cerclage Cable Fixation for Displaced Acetabular Fractures Using a Posterior Approach: A Retrospective Cohort Study. Medicina, 60.","DOI":"10.3390\/medicina60101659"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1016\/j.injury.2020.11.027","article-title":"Factors influencing functional outcomes following open reduction internal fixation of acetabular fractures","volume":"52","author":"Joseph","year":"2021","journal-title":"Injury"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1007\/s00590-024-04033-2","article-title":"Clinical and radiographic results of internal fixation of quadrilateral plate fractures of acetabulum","volume":"34","author":"Khamis","year":"2024","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"463","DOI":"10.5435\/JAAOS-D-22-00764","article-title":"Immediate Fixation of Acetabular Fractures Through an Anterior Approach Does Not Increase Morbidity or Mortality","volume":"31","author":"Hidden","year":"2023","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"106","DOI":"10.17816\/2311-2905-1747","article-title":"Surgical Approaches for Acetabulum Fracture Treatment: Analytic Review","volume":"28","author":"Kolesnik","year":"2022","journal-title":"Traumatol. Orthop. Russ."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"316","DOI":"10.5435\/JAAOS-D-23-00482","article-title":"Tranexamic Acid and Holding Venous Thromboembolism Prophylaxis Morning of Surgery Do Not Decrease Transfusion Requirements in Patients Undergoing Anterior Intrapelvic Approach for Acetabular Open Reduction and Internal Fixation","volume":"32","author":"Mullis","year":"2024","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1007\/s00590-024-03892-z","article-title":"Does local fat thickness correlate with post-operative infection in open reduction and internal fixation of acetabulum fractures?","volume":"34","author":"Weick","year":"2024","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"W\u00f3jcicki, R., Pielak, T., Walus, P.M., Jaworski, \u0141., Ma\u0142kowski, B., Jasiewicz, P., Gagat, M., \u0141apaj, \u0141., and Zabrzy\u0144ski, J. (2024). The Association of Acetabulum Fracture and Mechanism of Injury with BMI, Days Spent in Hospital, Blood Loss, and Surgery Time: A Retrospective Analysis of 67 Patients. Medicina, 60.","DOI":"10.3390\/medicina60030455"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1016\/j.jos.2023.10.007","article-title":"Superior gluteal artery injury in pelvic ring injury and acetabular fracture: Single center observational study","volume":"29","author":"Kwon","year":"2024","journal-title":"J. Orthop. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"155","DOI":"10.4103\/ijri.IJRI_414_18","article-title":"Pelvic muscle size and myosteatosis: Relationship with age, gender, and obesity","volume":"29","author":"Pacicco","year":"2019","journal-title":"Indian J. Radiol. Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"O20","DOI":"10.1111\/codi.12805","article-title":"Simple psoas cross-sectional area measurement is a quick and easy method to assess sarcopenia and predicts major surgical complications","volume":"17","author":"Jones","year":"2015","journal-title":"Colorectal Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"ziae047","DOI":"10.1093\/jbmrpl\/ziae047","article-title":"Muscle density, but not size, is independently associated with cognitive health in older adults with hip fractures","volume":"8","author":"Ge","year":"2024","journal-title":"JBMR Plus"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1002\/jcsm.13261","article-title":"Muscle size and density are independently associated with death after hip fracture: A prospective cohort study","volume":"14","author":"Wang","year":"2023","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"So, S.P., Lee, B.S., and Kim, J.W. (2021). Psoas Muscle Volume as an Opportunistic Diagnostic Tool to Assess Sarcopenia in Patients with Hip Fractures: A Retrospective Cohort Study. J. Pers. Med., 11.","DOI":"10.3390\/jpm11121338"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1007\/s00595-020-01980-1","article-title":"The psoas muscle index as a predictor of mortality and morbidity of geriatric trauma patients: Experience of a major trauma center in Kobe","volume":"50","author":"Nishimura","year":"2020","journal-title":"Surg. Today"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3543","DOI":"10.1007\/s00590-023-03739-z","article-title":"Underweight patients experience higher inpatient complication and mortality rates following acetabular fracture","volume":"34","author":"Wier","year":"2024","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.2106\/00004623-196446080-00001","article-title":"Fractures of the acetabulum: Classification and surgical approaches for open reduction. Preliminary report","volume":"46","author":"Judet","year":"1964","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3409","DOI":"10.1007\/s00590-024-03885-y","article-title":"Does the pararectus approach have better outcomes and fewer complications than the modified Stoppa approach for the fixation of acetabular fractures in adults: A systematic review and meta-analysis?","volume":"34","author":"Rajnish","year":"2024","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.jor.2024.05.003","article-title":"Comparative analysis of surgical approaches in acetabular fractures: Blood loss and procedural efficiency","volume":"61","author":"Ravanbod","year":"2024","journal-title":"J. Orthop."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"27","DOI":"10.64575\/t82bn688","article-title":"Demographic and clinical profiles of elementary versus associated acetabular fractures: Insights from a single-center study","volume":"1","author":"Demir","year":"2025","journal-title":"J. Multidiscip. Orthop. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2914086","DOI":"10.1155\/aort\/2914086","article-title":"Minimally Invasive Surgical Technique for the Extraperitoneal Fixation of Acetabulum Fracture: Technical Feasibility Study in Cadaver","volume":"2025","author":"Suomalainen","year":"2025","journal-title":"Adv. Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"718","DOI":"10.4055\/cios22199","article-title":"Arthroscopic Reduction and Internal Fixation in Patients with Acetabular Posterior Wall Fractures","volume":"15","author":"Hwang","year":"2023","journal-title":"Clin. Orthop. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1186\/s13018-024-05100-4","article-title":"The effects of prophylactic administration of tranexamic acid on the operative time and the amount of blood transfused during open fixation of pelvis and acetabulum fractures","volume":"19","year":"2024","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"112241","DOI":"10.1016\/j.injury.2025.112241","article-title":"Comparative evaluation and ranking of anterior surgical approaches for acetabular fractures: A systematic review and network meta-analysis","volume":"56","author":"Ramadanov","year":"2025","journal-title":"Injury"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e18395","DOI":"10.1097\/MD.0000000000018395","article-title":"Meta-analysis of modified Stoppa approach and ilioinguinal approach in anterior pelvic ring and acetabular fractures","volume":"99","author":"Wu","year":"2020","journal-title":"Medicine"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/6\/1036\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T11:45:43Z","timestamp":1779795943000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/6\/1036"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":26,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["medicina62061036"],"URL":"https:\/\/doi.org\/10.3390\/medicina62061036","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]}}}