Association Between Time to Definitive Surgical Fixation and Clinical Outcomes in Patients with Unstable Pelvic Fractures

Background: Unstable pelvic fractures represent life-threatening injuries associated with substantial hemorrhage, multi-organ dysfunction, and high mortality. The optimal timing of definitive surgical fixation remains a subject of considerable debate, particularly in resource-limited settings where logistical and infrastructural constraints frequently delay operative intervention.

Objectives: To evaluate the association between the time interval from injury to definitive surgical fixation and clinical outcomes—including postoperative complications, intraoperative blood loss, length of hospital stay, intensive care unit (ICU) duration, and functional recovery—in patients presenting with unstable pelvic fractures at a Al-Hilla General Teaching Hospital.

Methods: A retrospective cohort study was conducted on 95 patients with Tile Type B and Type C pelvic fractures treated between January 2018 and December 2022. Patients were stratified into two groups: early fixation (≤24 hours from injury) and delayed fixation (>24 hours). Primary outcomes included overall complication rates, intraoperative blood loss, and transfusion requirements. Secondary outcomes encompassed ICU and hospital length of stay, functional outcomes assessed by the Majeed Pelvic Outcome Score at six months, and mortality.

Results: The early fixation group (n = 52) demonstrated significantly lower intraoperative blood loss (680 ± 210 mL vs. 890 ± 275 mL; p = 0.001), reduced packed red blood cell transfusion requirements (2.8 ± 1.4 vs. 4.1 ± 1.9 units; p < 0.001), and shorter ICU (median 4 vs. 8 days; p < 0.001) and hospital stays (median 12 vs. 19 days; p < 0.001). The overall complication rate was significantly lower in the early group (34.6% vs. 62.8%; p = 0.006). Functional recovery at six months, measured by the Majeed Score, was superior in the early fixation group (74.2 ± 10.6 vs. 61.8 ± 13.4; p < 0.001). Multivariate analysis identified delayed fixation as an independent predictor of complications (adjusted OR = 3.21; 95% CI: 1.48–6.97; p = 0.003).

Conclusion: Early definitive surgical fixation of unstable pelvic fractures within 24 hours of injury is associated with significantly improved clinical outcomes in terms of blood loss, complication rates, length of stay, and functional recovery. Institutional protocols should prioritize timely stabilization in haemodynamically resuscitated patients.