Open research questions in Pelvic and Acetabular Injuries

What the literature leaves open

• Osteoporotic bone may limit fixation purchase, leading to loss of reduction, instability, or screw loosening and breakage. The study had to account for the limited number of events for the revision surgery/weightbearing restriction outcome. The study had to address the potential for collinearity in the multivariable models.

  Is anterior pelvic ring fixation associated with lower incidence of posterior hardware failure in elderly patients with pelvic ring injuries? · 2026 · DOI

• Chronic pain remains a significant challenge in orthopaedic trauma surgery, despite excellent functional and anatomical results. The relationship between radiographic reduction and chronic pain is complex and not well understood. Identifying predictors of chronic pain is crucial to developing effective treatment strategies.

  Chronic pain despite anatomical restoration: a prospective cohort study on one-year outcomes and pain predictors following spinopelvic fixation for trauma · 2026 · DOI

• The prevalence and predictors of chronic pain following spinopelvic fixation are not well understood. Comprehensive data on midterm to long-term patient-centered outcomes are limited. The relationship between radiographic reduction and chronic pain is not well characterized.

  Chronic pain despite anatomical restoration: a prospective cohort study on one-year outcomes and pain predictors following spinopelvic fixation for trauma · 2026 · DOI

• The lack of standardization in radiological assessment of pelvic reduction. The need for clarification of methodological issues in previous studies, including inconsistent labeling of the MattaTornetta criteria. The importance of controlling for baseline balance in subgroup comparisons.

  Letter to the Editor regarding “Quantitative assessment of pelvic reduction using a pretensioned external fixator in unstable pelvic injuries: a retrospective study” · 2026 · DOI

• The gap in the current literature is the lack of understanding of the factors associated with postoperative complications in traumatic high-energy pelvic fractures. The increasing incidence of high-energy pelvic fractures in Europe highlights the need for further research.

  Complications and outcomes after definitive surgery for traumatic high-energy pelvic fractures · 2026 · DOI

• The study is limited by single-observer assessment of SIJ morphology, which may introduce classification bias. Future work should include multiple observers, reliability testing, and prospective evaluation of the impact of SIJ variants on surgical decision-making and fixation outcomes.

  Sacroiliac joint variants are common and gender-specific but do not predict fracture pattern in pelvic ring injuries · 2026 · DOI

• The high stress on the steel alloy screw could lead to its breakage, resulting in treatment failure. The study also mentions the challenge of generalizing the results to the remaining population within the age group, who would present fewer challenges in terms of body size and weight.

  Sacroiliac fixation in pediatric patients: stability analysis by the finite element method · 2026 · DOI

• The dimensions of the S1 and S2 corridors were insufficient to allow safe screw placement, even when using a3.5-mm screw, for patients younger than 5 years of age.

  Sacroiliac fixation in pediatric patients: stability analysis by the finite element method · 2026 · DOI

• Limited research on bilateral acetabular fractures. Lack of understanding of the clinical and radiological outcomes of this rare injury pattern. Need for further studies to validate the observations and to better define factors affecting functional outcomes.

  “The double impact: insights into bilateral acetabulum fractures” · 2026 · DOI

• The lack of a standardized method for preoperative screw planning and X-ray simulation. The challenge of translating 3D CT-based anatomical information into 2D fluoroscopic projections. The need for a more accurate and reliable method for evaluating the deviation between preoperative planning and postoperative screw placement.

  Evaluation of preoperative screw planning and X-ray simulation for iliosacral and transsacral screw placement · 2026 · DOI

• The current classification schemes for pelvic fractures may not fully capture the complexity of pelvic ring injuries. The relationship between LSTP fractures and pelvic ring instability is not well understood. There is a need for a large cohort study to investigate the association between LSTP fractures and pelvic ring instability.

  Revisiting predictors of instability in pelvic ring injuries: are lumbar transverse process fractures significant? · 2026 · DOI

• The study had to adjust for baseline comorbidity using the Charlson Comorbidity Index. The study had to account for the retrospective design and lack of uniformly standardized CT data across patients.

  Demographic, surgical, and radiologic determinants of patient-reported outcomes, hospitalization, and return to work after acetabular fracture ORIF: a tertiary trauma center experience with a minimum two-year follow-up · 2026 · DOI

• The study highlights the challenge of developing planning paradigms that can accurately reflect the complexity of the intramedullary pathway of the pubic ramus.

  Limitations of CT-based planning in anterior pelvic ring fixation: a study of fluoroscopy-guided pubic ramus screws · 2026 · DOI

• Current CT-based planning paradigms rely on rectilinear geometric assumptions, which may not accurately reflect the complexity of the intramedullary pathway of the pubic ramus. The study identifies a gap in the current understanding of the factors that govern the feasibility of fluoroscopy-guided pubic ramus screw fixation.

  Limitations of CT-based planning in anterior pelvic ring fixation: a study of fluoroscopy-guided pubic ramus screws · 2026 · DOI

• The study faced challenges in terms of limited experience with the anterior intrapelvic approach in the trauma center. The study had to account for patient comorbidities using the American Society of Anesthesiologists (ASA) score. The study had to evaluate the reduction quality and complications of the approach.

  Learning curve analysis of the anterior intrapelvic approach for pelvic ring and acetabular fractures during implementation in a trauma center · 2026 · DOI

• The anatomical bone corridor in biologically female patients may not always accommodate screws with diameters of 8 mm, 7.3 mm, or even 6.5 mm. The lack of locking in the pubic bone can lead to secondary displacement and screw back-out. The natural curvature of the anterior pelvic ring can make the insertion of a straight screw challenging.

  Retrograde locked nailing of pubic ramus fractures: a technical note · 2026 · DOI

• Patient-specific hip geometry may influence acetabular fracture morphology. The study aims to explore the relationship between hip joint morphology and acetabular fracture in polytrauma patients.

  Association between hip joint morphology and acetabular fracture in polytrauma patients: a CT-based case–control study · 2026 · DOI

• The retrospective study design is limited by biases - Surgeon selection bias, as fixation principles and constructs utilized by the surgeons may vary from those implemented by others - Implant positional changes alone may not have clinical significance, and a larger sampling may be necessary to identify variables associated with complications - The causative mechanism behind these variables cannot be identified…

  Is anterior pelvic ring fixation associated with lower incidence of posterior hardware failure in elderly patients with pelvic ring injuries? · 2026 · DOI

• Explore how morphological variations affect surgical management, - Investigate joint stability and long-term functional results, - Include multiple observers and reliability testing in future…

  Sacroiliac joint variants are common and gender-specific but do not predict fracture pattern in pelvic ring injuries · 2026 · DOI

• Achieving anatomic reduction with a residual gap < 2 mm. Managing complex fractures with advanced age and longer injury-to-surgery intervals. Reducing the risk of neurovascular injury, substantial blood loss, and impaired healing.

  Minimally invasive screws fixation of displaced fractures of the acetabulum: a 7 years single center experience · 2026 · DOI

• Comparison of minimally invasive screws fixation with traditional open reduction and internal fixation, - Investigation of the long-term outcomes of minimally invasive screws fixation, - Evaluation of the technique in a larger patient population, - Assessment of the cost-effectiveness of minimally invasive screws…

  Minimally invasive screws fixation of displaced fractures of the acetabulum: a 7 years single center experience · 2026 · DOI

• Limited research examining the implications and injury patterns of ballistic and non-ballistic iliac fractures - Lack of understanding of the differences in injury patterns and outcomes between the two types…

  Mechanism matters: differences in injury patterns and outcomes between ballistic and non-ballistic iliac wing fractures · 2026 · DOI

• Precise equivalence of force magnitude, vector, and load transmission between cases and controls cannot be fully ensured, - The study is retrospective, - The sample size is limited to 84 polytrauma…

  Association between hip joint morphology and acetabular fracture in polytrauma patients: a CT-based case–control study · 2026 · DOI

• Limited evidence is available regarding the implementation of the AIP in less experienced settings, - The study was conducted at a single level-1 trauma center, - The operating surgeon had completed a dedicated fellowship in pelvic and acetabular fracture surgery, - No external proctoring was available during the implementation period, - The study had a limited number of outcome events…

  Learning curve analysis of the anterior intrapelvic approach for pelvic ring and acetabular fractures during implementation in a trauma center · 2026 · DOI

• The technique has several limitations, including the lack of locking in the pubic bone, - Very medial parasymphyseal fractures cannot be adequately fixed using this technique, - The study has a small sample size of only four…

  Retrograde locked nailing of pubic ramus fractures: a technical note · 2026 · DOI

Most-cited papers in Pelvic and Acetabular Injuries

• Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment · Injury · 2013 · 486 citations
• Open pelvic fractures: epidemiology, current concepts of management and outcome · Injury · 2004 · 272 citations
• Low-Risk Stress Fractures · The American Journal of Sports Medicine · 2001 · 237 citations
• Damage control orthopaedics in unstable pelvic ring injuries · Injury · 2004 · 234 citations
• Articular step-off and risk of post-traumatic osteoarthritis. Evidence today · Injury · 2010 · 231 citations
• Incidence of Colles' fracture in a North American community. · American Journal of Public Health · 1982 · 224 citations
• Direct retroperitoneal pelvic packing versus pelvic angiography: A comparison of two management protocols for haemodynamically unstable pelvic fractures · Injury · 2008 · 207 citations
• Haemodynamically unstable pelvic fractures · Injury · 2009 · 202 citations
• Epidemiology of pelvic ring injuries · Injury · 1996 · 199 citations
• Avulsion fractures of the pelvis · The American Journal of Sports Medicine · 1985 · 198 citations

Most recent work

• What Is the Effect of Robot Reduction in Displaced Pelvic Fractures? A Multicenter Randomized Clinical Trial · Clinical Orthopaedics and Related Research · 2026
• To pack or plug: American Association for the Surgery of Trauma multicenter evaluation of hemorrhage control interventions in pelvic fracture management · The Journal of Trauma: Injury, Infection, and Critical Care · 2026
• Early vs Late Surgical Intervention for Morel-Lavallée Injuries: A Pacific Coast Surgical Association Prospective Multicenter Study · Journal of the American College of Surgeons · 2026
• Biomechanical Comparison of Three Fixation Constructs for Tile Type C1.2 Pelvic Ring Fractures: A Finite Element Analysis · Life · 2026
• Complications and outcomes after definitive surgery for traumatic high-energy pelvic fractures · European Journal of Orthopaedic Surgery & Traumatology · 2026
• Delay in hip reductions due to the advent of rapid CT scans in the trauma setting · Archives of Orthopaedic and Trauma Surgery · 2026
• Operative care rates of lateral compression type 1 pelvic fractures increased from 2003 to 2018 · European Journal of Orthopaedic Surgery & Traumatology · 2026
• Multiple iliosacral screws in a single osseous fixation pathway: Utility and safety · Injury · 2026
• Unstable Pelvic ring fractures managed surgically: A 13-year cohort study of patient characteristics, associated injuries, and predictors of early mortality · Injury · 2026
• Robotic-assisted versus fluoroscopy-guided sacroiliac screw fixation: A retrospective comparative study · Injury · 2026

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