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Introduction: : Superior and inferior ramus fractures, termed straddle fractures, are high-energy fractures often accompanied by unstable pelvic ring injuries. However, consensus is lacking regarding indications for surgical treatment or fixation methods. We aimed to compare clinical and radiological outcomes of unilateral ramus fixation (URF) and bilateral ramus fixation (BRF) for straddle fractures with unilateral posterior pelvic ring injuries. Materials and methods: We enrolled 118 patients (73 males, 45 females; mean age, 47 years) diagnosed with straddle fractures between March 2015 and December 2021 with > 1 year of follow-up. Patients were divided into URF (n = 60) and BRF (n = 58) groups based on the anterior pelvic ring fixation method. Preoperative factors including body mass index, diabetes, smoking, injury mechanism, injury severity score, American Society of Anesthesiologists classification system, Tile classification, and Young and Burgess classification were compared. Intraoperative blood loss, operation time, postoperative bone union rate, complications, and the need for additional surgeries were analyzed. Results: There were no statistically significant preoperative differences between the two groups. However, the URF group showed a significantly lower mean operative time and blood transfusion requirement (63 min and 2 units, respectively) than the BRF group (104 min and 3 units, respectively) (both p < 0.001). Postoperatively, bone union was achieved in 57 (95.0%) and 56 (96.6%) patients in the URF and BRF groups, respectively. Complications occurred in 17 (28.3%) and 14 (24.1%) patients in the URF and BRF groups, respectively, with additional surgeries needed in 3 (5.0%) patients in the URF group and 2 (3.4%) patients in the BRF group. Conclusions: Unilateral anterior fixation can provide sufficient stability and clinical effectiveness in the surgical treatment of straddle fractures in areas with posterior pelvic ring injuries. Compared with bilateral anterior fixation, unilateral fixation significantly reduces operation time and blood loss, making it a viable fixation method for straddle fractures. [ABSTRACT FROM AUTHOR]

The S2-alar-iliac (S2AI) screws have been described as an alternative method for lumbosacropelvic fixation in place of iliac screws. However, the clinical effect of the short-segment S2AI screw fixation technique in the treatment of unstable posterior pelvic ring injuries remains unclear. In this study, we report the preliminary clinical results of the internal fixation connecting a S2-alar-iliac screw and a S1 pedicle screw (i.e., S2AI-S1 fixation) in the treatment of unstable pelvic posterior ring injuries. Twenty-five patients with unstable posterior pelvic ring injury were treated with S2AI-S1 fixation from February 2019 to June 2020. The incision length, surgical time, blood loss, frequency of intraoperative fluoroscopy, quality of reduction, complications, and functional outcome were analyzed. A total of 29 groups of S2AI-S1 fixation were used in 25 patients. The mean incision length was 8.3 (6.2 − 10.3) cm, mean operative time was 86.4 (60 − 142) minutes, mean frequency of intraoperative fluoroscopy was 7.9 (4 − 12) times, and mean blood loss was 148 (50 − 500) mL. The mean postoperative follow-up time was 17.8 (10 − 26) months. The satisfaction rate of pelvic reduction quality was 25/29, and the satisfactory rate of functional outcome was 23/25. There were no obvious signs of screw prominence, screw loosening, or implant failure. The case series presented in this study show the successful use of S2AI-S1 fixation to treat unstable posterior pelvic ring injuries. The S2AI-S1 fixation, not including the lumbar spine in the fixation range, is a simple, safe, and effective fixation method. [ABSTRACT FROM AUTHOR]