Fracture morphology guides the selection of closed versus open reduction in straddle fractures: outcomes of an indication-based treatment strategy
- 1Division of Orthopaedic Traumatology, Department of Orthopaedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Tao-Yuan, 33302 Taiwan
- 2Department of Orthopaedic Surgery, Musculoskeletal Research Center, Linkou Branch, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsin St. Kweishan, Tao- Yuan, 33302 Taiwan
Abstract
Purpose: To identify fracture characteristics associated with the selection of closed reduction (CR) or open reduction (OR) for anterior pelvic ring fixation in patients with straddle fractures and to evaluate the radiographic, functional, and complication outcomes following an indication-based treatment strategy.
Methods: This retrospective study included 69 patients with straddle fractures treated surgically between 2016 and 2021. Patients were classified according to the anterior pelvic ring reduction technique as bilateral CR (n = 25) or OR on at least one side (n = 44). Fracture characteristics associated with treatment selection were analyzed, and perioperative, radiographic, functional, and complication outcomes were compared between groups.
Results: Compared with fracture sites treated with CR, fracture sites treated with OR more frequently demonstrated medial involvement and greater axial displacement. After adjustment for potential confounders, medial fracture involvement and AO/OTA Type A injury, compared with Type B injury, were independently associated with the selection of OR. OR was associated with longer operative time and greater blood loss (both P < 0.001). Radiographic reduction was maintained during follow-up, and no significant differences were observed between groups in radiographic stability, overall functional outcomes, or postoperative complication rates.
Conclusions: Medial fracture involvement was independently associated with the selection of OR. AO/OTA Type A injury was also associated with OR, although this estimate was imprecise and should be interpreted cautiously. These findings support an indication-based treatment strategy guided by fracture morphology and the anticipated feasibility of satisfactory indirect reduction.
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BibTeX
@article{tsai2026fracture,
title = {{Fracture morphology guides the selection of closed versus open reduction in straddle fractures: outcomes of an indication-based treatment strategy}},
author = {Ping‑Jui Tsai and Chih-Yang Lai and Yung-Heng Hsu and Ying-Chao Chou and Yi-Hsun Yu},
journal = {Langenbeck's Archives of Surgery},
year = {2026},
month = jul,
doi = {10.1007/s00423-026-04174-4},
url = {https://doi.org/10.1007/s00423-026-04174-4},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Fracture morphology guides the selection of closed versus open reduction in straddle fractures: outcomes of an indication-based treatment strategy
AU - Ping‑Jui Tsai
AU - Chih-Yang Lai
AU - Yung-Heng Hsu
AU - Ying-Chao Chou
AU - Yi-Hsun Yu
PY - 2026
DA - 2026/07/31
JO - Langenbeck's Archives of Surgery
DO - 10.1007/s00423-026-04174-4
UR - https://doi.org/10.1007/s00423-026-04174-4
AB - Purpose: To identify fracture characteristics associated with the selection of closed reduction (CR) or open reduction (OR) for anterior pelvic ring fixation in patients with straddle fractures and to evaluate the radiographic, functional, and complication outcomes following an indication-based treatment strategy. Methods: This retrospective study included 69 patients with straddle fractures treated surgically between 2016 and 2021. Patients were classified according to the anterior pelvic ring reduction technique as bilateral CR (n = 25) or OR on at least one side (n = 44). Fracture characteristics associated with treatment selection were analyzed, and perioperative, radiographic, functional, and complication outcomes were compared between groups. Results: Compared with fracture sites treated with CR, fracture sites treated with OR more frequently demonstrated medial involvement and greater axial displacement. After adjustment for potential confounders, medial fracture involvement and AO/OTA Type A injury, compared with Type B injury, were independently associated with the selection of OR. OR was associated with longer operative time and greater blood loss (both P < 0.001). Radiographic reduction was maintained during follow-up, and no significant differences were observed between groups in radiographic stability, overall functional outcomes, or postoperative complication rates. Conclusions: Medial fracture involvement was independently associated with the selection of OR. AO/OTA Type A injury was also associated with OR, although this estimate was imprecise and should be interpreted cautiously. These findings support an indication-based treatment strategy guided by fracture morphology and the anticipated feasibility of satisfactory indirect reduction.
SN - 1435-2443
SN - 1435-2451
ER -