BACKGROUND: Surgical fixation of pelvic ring fractures carries a substantial risk of postoperative complications, particularly surgical site infection, yet the relative contribution of fracture pattern and associated soft tissue injury to this risk remains incompletely defined.
OBJECTIVE: To describe the rate and spectrum of complications following surgical fixation of pelvic ring fractures and to identify factors independently associated with these complications, with particular attention to acute surgical site infection.
METHODS: Retrospective, single-center cohort study of 126 patients who underwent surgical fixation of pelvic ring fractures between December 2014 and November 2024, reported in accordance with the STROBE statement. Candidate demographic, injury-related, and treatment-related exposures were compared against a composite primary outcome (any postoperative complication) and against acute infection using Fisher's exact test, Pearson chi-square test, the Mann-Whitney U test, and multivariable logistic regression.
RESULTS: Overall, 39 of 126 patients (31.0%) experienced at least one postoperative complication; chronic pain (22.2%) and acute surgical site infection (16.7%) were the most frequent individual components. In bivariate analysis, the presence of a Morel-Lavallée lesion at baseline was significantly associated with both the composite outcome (OR 12.65, 95% CI 1.42-112.27, p = 0.011) and acute infection (OR 12.12, 95% CI 2.06-71.37, p = 0.007); Young-Burgess fracture pattern was also associated with infection (p = 0.018). After multivariable adjustment for infection, a Morel-Lavallée lesion (adjusted OR 17.69, 95% CI 2.46-126.95, p = 0.004) and combined-mechanism fracture pattern (adjusted OR 8.25 versus anteroposterior compression, 95% CI 1.91-35.58, p = 0.005) remained independently associated with infection. Neither the presence, technique, nor surgical approach of posterior ring fixation was associated with any complication type, and time from injury to definitive fixation (median 13 days) showed no significant association with either outcome.
CONCLUSION: A Morel-Lavallée lesion identified at initial evaluation was associated with postoperative complications in bivariate analysis and, together with a combined-mechanism fracture pattern, remained an independent predictor of surgical site infection after multivariable adjustment. No statistically significant association was identified between posterior fixation technique and complication risk.
LEVEL OF EVIDENCE: III, retrospective cohort study.
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