Delayed reduction of tile C pelvic ring injuries and evidence-based management strategies.

BACKGROUND: Delayed reduction of displaced pelvic ring fractures poses considerable surgical challenges. This study aimed to assess the reduction timing and effectiveness of various reduction strategies for delayed treatment of Tile C pelvic ring fractures. MATERIALS AND METHODS: Between January 2020 and September 2023, 38 patients with Tile C type pelvic ring fractures, including 4 type C1, 16 type C2, and 18 type C3, underwent delayed reduction (more than a 10-day interval from injury to surgery) through different techniques, were retrospectively reviewed. Intraoperatively, closed reduction using Schanz pin traction or the Starr Frame-assisted Unlocking Closed Reduction Technique (UCRT) were preferred. If the above closed reduction fails, open reduction by using lumbo-iliac pedicle screw system was forced. The reduction quality was radiographically assessed according to Matta Pelvic Score. And the lower-extremity functionality was clinically evaluated by Majeed function score standard. RESULTS: The 38 patients underwent a follow-up period ranging from 18 to 41 months. Closed reduction was successfully accomplished in 24 cases. Among these, two cases (type C1-1 and C1-2) achieved excellent reduction through the employment of Schanz pins technique. Additionally, 22 cases (comprising 2 of type C1-2, 16 of type C2, and 4 of type C3) that underwent UCRT resulted in excellent reduction for 11 patients, good reduction for 8 patients, and fair reduction for 3 patients. Following the failure of closed reduction, 14 patients with type C3 fractures underwent conversion to open reduction, and subsequently achieved excellent reduction. All patients achieved bony union (mean, 4.34 months). According to the average Majeed functional score, the lower-extremity functionality was deemed excellent in 2 patients using Schanz pins technique, 12 patients via UCRT and 9 patients by means of open reduction; good in 9 patients utilizing UCRT and 5 patients undergoing open reduction; and fair in 1 patient employing UCRT. In three cases, sensory nerve damage occurred, with a later complete recovery. CONCLUSION: For Tile type C pelvic fractures, early surgical intervention (within 10 days post-injury) may allow superior closed reduction outcomes. The Schanz pin technique appears well-suited for minimally displaced Tile C1-1/C1-2 pelvic fractures. The UCRT technique demonstrates favorable reduction outcomes in Tile C1/C2 fractures, whereas its effectiveness is comparatively limited in the management of C3 injuries. In such complex cases, particularly when UCRT fails, the ilio-lumbar pedicle screw technique offers a reliable alternative.