Comparative Evaluation of Closed Versus Open Reduction Techniques in Straddle Fractures: A Retrospective Analysis of 69 Patients

Abstract

Abstract Background Osteosynthesis techniques for addressing straddle fractures include closed reduction and fixation (CRF) and open reduction and fixation (ORF). Although CRF offers the advantage of being a minimally invasive surgery, ORF ensures precise reduction and secure fixation. The optimal surgical approach, whether employing CRF or ORF, to achieve superior osteosynthesis outcomes remains uncertain. This study aimed to compare the perioperative characteristics of the two methods and identify an optimal treatment approach tailored to each clinical indication. Methods We performed a retrospective analysis of patients with pelvic ring injuries at a single trauma center admitted between 2016 and 2021. Among this cohort, 69 patients with straddle fractures, with or without posterior pelvic ring injuries, were identified. The patients were categorized into two groups based on the treatment protocol: the CRF and ORF groups. Preoperative conditions, intraoperative features, and radiological outcomes were systematically compared and analyzed. Results A total of 69 patients with 138 superior pubic rami fractures underwent surgical treatment using either closed (57 superior pubic rami) or open (81 superior pubic rami) methods. Application of CRF significantly prevented fractures in Nakatani zone I (P = 0.003). ORF was employed for segmental fractures of the pubic ramus (P = 0.03) and fractures with greater displacement in the axial plane (P = 0.03). Additionally, ORF resulted in a more symmetric pelvic reduction according to the Lefaivre criteria (P = 0.003). Conclusion Both CRF and ORF demonstrated the ability to achieve satisfactory radiological outcomes in straddle fractures. The use of an established treatment protocol can assist surgeons in making informed decisions regarding the optimal treatment approach. Level of Evidence Therapeutic III

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