Short-Term Outcomes of Unstable Pelvic Fractures in Adults Treated at Mulago National Referral Hospital

Short-Term Outcomes of Unstable Pelvic Fractures in Adults Treated at Mulago National Referral Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Short-Term Outcomes of Unstable Pelvic Fractures in Adults Treated at Mulago National Referral Hospital Atuhaire Rodgers, Bangirana Alexander, Malagala Joseph Michael, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7381693/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Pelvic fractures are a significant health issue, with over 4.5 million new cases annually and high morbidity and mortality. Unstable pelvic fractures, affecting the posterior pelvic ring, pose severe hemorrhage risks and poor outcomes. Classification systems like Tile and Young-Burgess aid in management. Current treatment emphasizes early hemorrhage control and surgical stabilization for better recovery. Functional outcomes, measured with the Majeed score, depend on injury severity and care quality. Given the limited research on short-term outcomes in sub-Saharan Africa, this study aims to evaluate the short-term radiological and functional outcomes, as well as predictors of functional outcomes of unstable pelvic fractures in adults at Mulago National Referral Hospital. Methods A cross-sectional study was conducted on 51 patients who met the inclusion criteria. Functional outcomes were assessed using the Majeed Pelvic score, while Radiological outcomes were evaluated for bony union, non-union, and malunion. Data was collected using a structured questionnaire and analyzed using STATA version 15. Results The median age was 31 (IQR 25,38), and the male sex dominated 56.9% (n = 29). A satisfactory functional outcome was observed among 57% (n = 29) of the patients. Radiological union occurred among 78% (n = 40) of the patients. Significant predictors of unsatisfactory outcomes were primary (APR = 1.23, 95% CI: 1.03–1.46, p = 0.023), nerve damage (APR = 1.31, 95% CI: 1.09–1.59, p = 0.005), and fracture management (APR = 1.24, 95% CI: 1.05–1.46, p = 0.011). Conclusion Nearly half of patients with unstable pelvic fractures in Uganda experience unsatisfactory short-term functional outcomes, with low education, nerve injury, and non-operative management as key predictors. Early anteroposterior malalignment also significantly affects function, highlighting the need for patient education and timely, precise surgical care Unstable pelvic fractures short-term outcomes Majeed Pelvic score Figures Figure 1 Figure 2 Figure 3 BACKGROUND Pelvic fractures pose a significant global health challenge, with around 4.5 million new cases and 13.1 million existing cases reported in 2021, resulting in 2.2 million years lived with disability ( 1 ). The global incidence rate stands at 56.00 per 100,000 population, with Sub-Saharan Africa showing low prevalence rates (77.37 per 100,000) but increasing disease burden ( 1 , 2 ). Ethiopia reports a 1.97% incidence among trauma patients, primarily affecting males (87.5%) with an average age of 31.93 ( 3 ). In South Africa, pelvic fractures account for approximately 16% of major trauma injuries ( 4 ), while in Uganda, unstable pelvic fractures comprise 16.7% of pelvic fracture cases ( 5 ). The clinical significance of pelvic fractures extends beyond their mechanical implications, as these injuries are associated with substantial morbidity and mortality rates ( 6 – 8 ). Overall mortality from pelvic fractures ranges from 4.9–16%, with mortality rates significantly higher for unstable pelvic fractures, reaching 8.3% in the United States ( 6 – 8 ). The high mortality is primarily attributed to life-threatening hemorrhage from retroperitoneal bleeding sources, with venous bleeding accounting for more than 90% of cases and arterial bleeding sources comprising less than 10% ( 9 ). The pelvic bowl can contain approximately 1,500cc of blood, and this volume increases exponentially in mechanically unstable pelvic ring injuries, with pelvic volume increasing by 20% with a 5cm pubic symphysis disruption and up to 40% with a 10cm diastasis ( 9 ). Unstable pelvic fractures, defined as those with disruption of the posterior pelvic ring structures, represent the most challenging subset of these injuries ( 10 – 12 ). According to the widely used Tile classification system, unstable fractures are classified as Type B (rotationally unstable, vertically stable) or Type C (rotationally and vertically unstable) injuries ( 10 – 12 ). The Young-Burgess classification, based on injury mechanism, categorizes unstable patterns as anteroposterior compression (APC) type II/III, lateral compression (LC) type III, vertical shear (VS), and combined mechanism (CM) injuries ( 10 – 12 ). These classification systems are fundamental for treatment planning and prognostication, as they correlate with injury severity, hemorrhage risk, and clinical outcomes ( 10 – 12 ). The management of unstable pelvic fractures has evolved significantly over the past decades. Contemporary treatment approaches emphasize damage control principles with early hemorrhage control, followed by definitive surgical stabilization when the patient’s physiological status permits ( 10 , 13 , 14 ). Operative management has become increasingly favored over conservative treatment as it allows for earlier mobilization, reduces complications associated with prolonged recumbency, and enables correction and prevention of significant pelvic deformities, thereby improving clinical outcomes ( 14 ). Treatment modalities include external fixation for emergency stabilization, followed by definitive internal fixation through various approaches including percutaneous screw fixation, open reduction and internal fixation, or combined techniques ( 15 , 16 ). Despite advances in treatment protocols, the long-term functional and radiological outcomes of unstable pelvic fractures remain variable and are influenced by multiple factors ( 15 ). Studies have reported functional outcomes using various scoring systems, with the Majeed score being the most commonly employed assessment tool ( 15 – 17 ). Excellent to good functional outcomes have been reported in 70–93% of patients, though these results vary based on fracture pattern, associated injuries, and treatment methods ( 15 , 16 , 18 ). Radiological outcomes are typically assessed by residual displacement, with excellent results defined as displacement of less than 5 mm ( 16 , 19 ). Studies have shown that 43–66% of patients achieve excellent radiological results ( 16 , 19 ). Several factors have been identified as predictors of poor functional outcomes in patients with unstable pelvic fractures. These include advanced age, female gender, high injury severity scores, complex trauma patterns, associated injuries (particularly neurological, urogenital, and lower extremity injuries), fracture instability, and inadequate reduction ( 17 , 20 – 23 ). The presence of nerve damage has been consistently identified as one of the strongest predictors of poor long-term functional outcome, with odds ratios as high as 66.9 for unsatisfactory results ( 21 ). Additionally, the quality of radiological reduction appears to correlate with functional outcomes, with patients achieving excellent reduction showing superior functional performance ( 16 , 24 ). Recovery patterns following unstable pelvic fractures demonstrate that most improvement occurs within the first 18 months post-injury, with patients experiencing significant reductions in health-related quality of life, particularly within the first three months ( 17 , 21 ). While continuous improvement is observed up to 12–24 months, many patients do not achieve their pre-injury functional status ( 17 ). The burden of these injuries extends beyond the immediate clinical impact, with studies showing that only 59–77% of patients return to work and 75% achieve independent living two years post-injury ( 17 ). Given the complexity of unstable pelvic fractures and varying reported outcomes, there is need for a comprehensive evaluation of short-term functional and radiological results, especially in sub-Saharan Africa, where healthcare resources differ significantly from high-income countries. Most studies on this topic come from developed healthcare systems, limiting their relevance to resource-constrained settings ( 1 , 4 ). Furthermore, there is a lack of data on short-term outcomes within the first 12 months post-injury, as many studies focus on long-term results ( 19 , 21 ). This study aims to determine the short-term functional and radiological outcomes of unstable pelvic fractures in adults treated at Mulago National Referral Hospital (MNRH). It will also determine the factors associated with these outcomes, thereby contributing valuable data to guide clinical decision-making and improve patient care in this challenging clinical scenario. Methods Aim, Study Design and Setting This study aimed to assess the functional outcomes of patients with unstable pelvic fractures and determine the associated predictors. It also evaluated the short-term radiological outcomes of patients with unstable pelvic fractures. This was a cross-sectional study conducted from November 2024 to February 2025 at MNRH, Uganda’s largest National Referral Hospital and teaching facility for the Makerere College of Health Sciences. The study evaluated patients who sustained unstable pelvic fractures and had been previously treated at MNRH between November 2023 and April 2024. Ethics Approval and Consent Ethical clearance was obtained from the Makerere School of Medicine Research and Ethics Committee (SOMREC), and informed consent was obtained from all participants before study enrollment. Participant Selection and Eligibility Criteria The study included adult patients (≥ 18 years) who sustained unstable pelvic fractures from November 2023 to April 2024, had been previously treated at MNRH, and had available prior radiological imaging. Unstable pelvic fractures were defined according to the Modified AO Tile classification, including only Tile Type B and Type C fractures. Exclusion criteria included patients with pathological fractures, concomitant acetabular fractures, and those who were mentally incapacitated. Patients’ information was obtained from charts from the Hospital Records Registry, including their telephone numbers, and eligible participants were given appointments to attend the Orthopedic Department for assessment. Treatment Protocols For patients managed conservatively, bed rest for 6 weeks with pelvic binders or skeletal traction was advised according to the fracture patterns. For operatively managed patients, rehabilitation was individualized based on associated injuries. Once pelvic ring stability was achieved, bedside exercises, including rolling and passive/active stretching, were initiated, followed by ambulation training using crutches or wheelchairs. All patients were advised to avoid full weight-bearing on the affected side for the initial 3 months. Data Collection Team and Training The research team consisted of the principal investigator and 2 research assistants who were qualified Orthopedic officers. The team underwent 2 weeks of training and orientation on research tool usage, with particular emphasis on completing the Majeed Pelvic Score tool. The research assistants worked under supervision during the initial part of the study until deemed proficient to work independently. Outcome Measurements and Variables Primary outcome: Functional outcome was assessed using the Majeed Pelvic Score tool. Patients received an overall percentage score and were graded as excellent (> 85), good (70–84), fair (55–69), and poor (< 55). These categories were further classified into satisfactory (excellent or good) or unsatisfactory (fair or poor) outcomes ( 21 ). Clinical assessment included detailed physical examination by the principal investigator, incorporating neurological assessment and measurement of any leg length discrepancy. Radiological assessment included follow-up pelvic radiographs with anteroposterior (AP), inlet, and outlet views. Patients were requested to bring their immediate post-injury radiographs to enable pelvic fracture classification by the radiologist. Radiological parameters assessed included vertical displacement and anteroposterior displacement graded using Henderson criteria, rotational displacement graded using Lefaivre criteria, and evaluation for radiological union, non-union, symphysis diastasis, and mal-union. Additional variables collected through structured questionnaire included age, sex, marital status after injury, mechanism of injury, occupation after injury, Tile’s fracture type, treatment modality, associated injuries, and adherence to rehabilitation protocol. Data collection was conducted in Luganda and English languages. Sample Size Estimation The sample size was calculated using a two-proportion formula comparing unsatisfactory functional outcomes between Tile B and Tile C pelvic fractures. The calculation assumed a 5% significance level, 80% power, and proportions of 26% and 18% unsatisfactory outcomes for Tile B and Tile C groups, respectively ( 1 , 6 ). Using finite population correction for the study population and adjusting for a 20% non-response rate, a final sample size of 51 patients was determined and enrolled. Statistical Analysis Data were analyzed using STATA version 15. Continuous variables were summarized as medians with interquartile ranges, while categorical variables were presented as frequencies and proportions. At bivariate analysis, a modified Poisson regression model was applied, and variables with p-values < 0.05 were considered statistically significant. Variables with p-values < 0.2 at bivariate analysis were included in the multivariate model, where p-values < 0.05 were considered statistically significant predictors of functional outcomes. Stepwise regression and correlation analysis were performed to control for confounding, with correlation coefficients < 0.4 deemed acceptable to minimize multicollinearity. For short-term radiological outcomes, associations between radiological union and either functional outcome or fracture type were evaluated using Fischer’s exact test when cell counts were ≤ 5, and the Chi-square test when counts were > 5. RESULTS The median age was 31 years (IQR: 25–38), with males comprising 56.9% (n = 29) of the cohort. Type B fractures were the most common, accounting for 60.8% (n = 31) of cases. The majority of patients underwent surgical treatment (54.9%, n = 28), while only 11.8% (n = 6) did not adhere to the rehabilitation protocol. Sociodemographic and clinical characteristics are detailed in Table 1 . Table 1 Sociodemographic and clinical characteristics of patients with unstable pelvic fractures. Variable Frequency (n)/Median (IQR) Percent (%) Age (years) 31 ( 25 , 38 ) Sex Male 29 56.9 Female 22 43.1 Occupational Status after Injury No occupation 35 68.6 Have occupation 16 31.4 Mechanism of Pelvic Injury Road traffic accident 45 88.2 Fall from height 6 11.8 Fracture Type Type B 31 60.8 Type C 20 39.2 Associated Injuries Extra-skeletal 20 39.2 Skeletal 14 27.5 None 17 33.3 Fracture Management Approach Operative 28 54.9 Non-operative 23 45.1 Leg Length Discrepancy > 2 cm No 29 56.9 Yes 22 43.1 Having Nerve Damage No 40 78.4 Yes 11 21.6 Rehabilitation Protocol Followed Yes 45 88.2 No 6 11.8 Short-term functional outcomes. Overall, 57% (n = 29) of patients achieved satisfactory functional outcomes (Fig. 1 ), with 64.5% (n = 20) of Type B and 45% (n = 9) of Type C fractures reaching this outcome. Short-term radiological outcomes. Among the 51 patients, 11% (n = 6) exhibited poor vertical displacement, 31% (n = 20) had poor rotational displacement, and 7.8% (n = 4) showed poor anteroposterior displacement (Fig. 2 ). Analysis of radiological displacement in relation to fracture type, management modality, and functional outcomes revealed that fracture type (Tile B vs. C) was significantly associated with vertical displacement (p = 0.002), while functional outcome correlated significantly with anteroposterior displacement (p = 0.029). (Fig. 2 ) Additionally, 22% (n = 11) of patients demonstrated non-union on radiological assessment (Fig. 3 ). There was no significant association between radiological union and functional outcome or fracture type. Factors associated with short-term functional outcomes. In the bivariate analysis, marital status, education level, leg length discrepancy, nerve damage, and fracture management were significantly associated with worse outcomes (p < 0.05). These significant variables, together with associated injuries and fracture type (p < 0.2), were considered for the multivariate model. Following stepwise regression and correlation checks to control for multicollinearity, only nerve damage, education level, and fracture management remained in the final multivariate model, and all were statistically significant. Participants with primary education were 23% more likely to have unsatisfactory outcomes compared to those with secondary education (APR = 1.23, 95% CI: 1.03–1.46, p = 0.023). Those with nerve damage were 31% more likely to experience unsatisfactory outcomes than those without (APR = 1.31, 95% CI: 1.09–1.59, p = 0.005). Similarly, patients managed non-operatively were 24% more likely to have unsatisfactory outcomes compared to those managed operatively (APR = 1.24, 95% CI: 1.05–1.46, p = 0.011)(Table 2 ). Table 2 Multivariate analysis of factors associated with functional outcomes Variables Unsatisfactory Satisfactory APR (95% CI) p-value n (%) n (%) Education level Secondary 17(73.9) 6(26.1) 1 Tertiary 2(28.6) 5(71.4) 1.23(0.96–1.57) 0.104 Primary 10(47.6) 11(52.3) 1.23(1.03–1.46) 0.023 Nerve damage No 27(67.5) 13(32.5) 1 Yes 2(9.5) 19(90.5) 1.31(1.09–1.59) 0.005 Fracture management Operatively 21(75.0) 7(25.0) 1 Non-operatively 8(34.8) 15(65.2) 1.24(1.05–1.46) 0.011 DISCUSSION The study shows that a high proportion (43.1%) of patients had unsatisfactory short-term functional outcomes following treatment of unstable pelvic fractures. This could be explained by the lack of adherence to post-management instructions by the patients and the conservative management of some unstable pelvic fractures ( 10 ). Another reason for the relatively high number of unsatisfactory outcomes may be due to our study’s relatively shorter patient follow-up. It has been reported that patients with longer than 5 years of follow-up had better outcomes than those followed up for one year ( 25 ). This finding is consistent with studies by Kokubo, Oki ( 21 ) and Nana, Ngo-Yamben ( 26 ) which observed 36.6% and 42% unsatisfactory functional outcomes, respectively. However, this is in contrast to findings by Verma et al, in India among patients with unstable pelvic fractures, who observed that 27% of the patients had unsatisfactory functional outcomes ( 27 ). This could be attributed to the fact that their sample size was larger (n = 112) compared to our study (n = 51), and their study design was a cohort, whereas ours was cross-sectional. Our study also showed that 60.8% sustained Tile Type B pelvic fractures, while a smaller proportion had Type C injuries. This predominance likely reflects common injury mechanics like lateral compression and open-book mechanisms that lead to rotationally unstable but vertically stable fractures ( 28 ). Similar findings have been reported elsewhere; for instance, a Swiss multicenter study noted Type B fractures accounted for 54% of pelvic ring injuries, while Type C comprised 28% ( 29 ). Another study by the Dutch series showed Type B fractures at 39.3% and Type C at 35.2% ( 30 ). In contrast, other studies report varying proportions; for instance, in a recent reliability study of Tile classification, Type C fractures were actually more common (43%) than Type B (34%) among 238 cases ( 31 ). Such divergence could be due to differences in patient population, referral pathways, or the nature of the healthcare setting, tertiary trauma centers may see a different spectrum of severity, and classification biases or imaging practices may also play a role ( 24 , 29 ). Demographically, we identified a lower education level as a risk factor: participants with only a primary education were 23% more likely to experience unsatisfactory outcomes. This finding represents a novel contribution to the pelvic trauma literature, as education level has not been extensively studied as a prognostic factor in this population. This association likely reflects various underlying mechanisms, including health literacy, treatment compliance, and socioeconomic factors that influence access to rehabilitation and outcomes ( 17 ). Generally, higher education is associated with a better understanding of treatment protocols, adherence to physiotherapy, and earlier recognition of complications, all of which contribute to improved functional recovery ( 17 , 32 ). Patients with neurological injuries also demonstrated poorer function; those with nerve damage were 31% more likely to have unsatisfactory outcomes. Nerve injuries, such as lumbosacral plexus or sacral nerve root lesions, can result in persistent motor or sensory deficits and chronic pain, directly impairing function ( 18 , 33 ). This is consistent with prior reports that neurological deficits following pelvic trauma predict a poor recovery. For instance, Ghosh, Aggarwal ( 18 ) identified associated nerve injuries as significantly linked to poorer functional scores, and Brian Weatherford ( 33 ) notes that neurological injuries are known predictors of adverse outcomes in pelvic fractures. We found that non-operative management was associated with poorer outcomes: patients who did not undergo surgery were 24% more likely to have unsatisfactory results. This supports the established consensus that unstable pelvic injuries often benefit from surgical fixation, which facilitates stabilization, restores alignment, and enables early mobilization, key factors in improving functional recovery ( 34 ). Historical data reinforce this, showing that non-operative approaches such as prolonged bed rest, casting, or external fixation may lead to malunion in up to 80% of cases, particularly when used for unstable pelvic fractures ( 34 ). Supporting our study, Kokubo, Oki ( 21 ) identified conservative treatment as a strong independent predictor of poor short-term functional outcomes in unstable pelvic ring fractures, reporting an odds ratio of approximately 13.7 for unsatisfactory results compared to operative treatment. However, not all evidence aligns uniformly. For example, a recent randomized pilot trial in elderly patients with low-energy posterior pelvic (FFP II) fractures found no significant difference in functional outcomes between conservative and surgical groups at one year (measured by pain, mobility, quality of life, or mortality) ( 35 ). This discrepancy likely stems from differences in patient populations (frail elderly with low-energy injuries amenable to conservative management) and follow-up duration, which in their study was longer and focused on stable or minimally displaced fractures. On radiographs, we observed that 11% of patients had poor vertical alignment, 31% had poor rotational alignment, and 7.8% had poor anteroposterior (AP) alignment. Rotational malalignment was the most common issue in our series, perhaps due to the technical challenges of correcting pelvic ring twist ( 36 ). As expected, vertical displacement strongly correlated with fracture type (p = 0.002): vertically unstable (Tile C) injuries typically result in cranial-caudal asymmetry of the hemipelvis. Significant vertical offset is known to have functional consequences; for example, uncorrected superior migration greater than 2 cm can lead to leg length discrepancies and gait disturbances ( 36 ). We also found that worse AP displacement (indicating symphyseal or sacroiliac joint diastasis) was significantly correlated with poorer functional outcomes (p = 0.029). This is logical, as AP displacement often indicates sacroiliac joint incongruity; indeed, pelvic injury reviews identify sacroiliac joint displacement greater than 1 cm as a risk factor for chronic pain and disability ( 33 ). Thus, our data suggest that even subtle malalignments in the anterior-posterior direction may more directly impact early mobility. In contrast, some authors have reported that small residual displacements (up to approximately 1 cm) do not necessarily worsen short-term Majeed scores ( 37 ). The differing findings likely arise from the thresholds chosen and individual patient factors, but overall, our evidence supports that gross malalignment (in any plane) is detrimental. We observed that 22% of patients exhibited radiographic evidence of non-union at short-term follow-up. This rate is significantly higher than the approximately 5% non-union rate typically reported in broader studies ( 38 ). This discrepancy likely arises from our strict radiographic criteria and the relatively early follow-up period; incomplete healing at 6–8 months can be interpreted as “non-union” on X-rays, even if eventual healing does occur. Importantly, unlike vertical or rotational displacement, radiological non-union was not significantly associated with fracture type or functional status in our study. This indicates that, in the short term, factors such as malalignment and neurologic injury are more critical to functional outcomes than delayed bone healing, which may take longer to become symptomatic ( 33 , 38 ). The published literature on early non-union rates in pelvic fractures is limited; however, it is well known that persistent instability (nonunion or malunion) can ultimately lead to pain and disability, highlighting the importance of follow-up ( 33 , 38 ). Our study has some limitations. A central limitation of this study is its cross-sectional design, which offers a snapshot of outcomes at a single time point, thereby precluding any assessment of causality or temporal progression of functional and radiological recovery. To overcome this, future studies could adopt longitudinal or repeated cross-sectional designs, allowing researchers to track trajectory changes over time and better infer cause-and-effect relationships. The sample size, 51 patients, though calculated using finite population correction and a 20% non-response buffer, still limits statistical power to detect smaller but clinically relevant associations; future studies could aim for larger, multi-center cohorts, incorporating pre-study power analyses to ensure adequate effect detection. Finally, the study assessed only short-term outcomes, limiting our understanding of long-term functional status and radiological progression; this could be addressed through extended follow-up, such as beyond 6–12 months, to capture recovery trajectories, late complications, and long-term union rates. Despite these limitations, our findings underscore important determinants of outcomes in pelvic fractures: roughly half of the patients recover well by early follow-up; however, the risk of poor outcomes is higher among those with lower education levels, neurological injuries, or those who receive nonoperative management. Properly aligning fractures, particularly correcting rotational deformity and sacroiliac joint incongruity, may enhance function. Future prospective, multi-center studies with longer follow-up periods are necessary to confirm these predictors and improve management strategies to optimize recovery from pelvic fractures. Conclusion Nearly half of patients with unstable pelvic fractures at Uganda’s main trauma referral center experience unsatisfactory short-term functional outcomes, with lower education level, neurological injury, and non-operative management emerging as key predictors of poor recovery. Radiological findings further emphasize that malalignment, particularly in the anteroposterior plane, has a stronger early functional impact than delayed union. These results underscore the importance of patient education, timely surgical stabilization where indicated, and meticulous attention to fracture alignment in optimizing recovery. Abbreviations AO Arbeitsgemeinschaft für Osteosynthesefragen (Association for the Study of Internal Fixation) AP Anteroposterior APC Anteroposterior Compression APR Adjusted Prevalence Ratio CI Confidence Interval CM Combined Mechanism IQR Interquartile Range LC Lateral Compression MNRH Mulago National Referral Hospital SOMREC School of Medicine Research and Ethics Committee VS Vertical Shear Declarations Ethics approval and consent to participate This study was approved by the Makerere School of Medicine Research and Ethics Committee (SOMREC), reference number [Mak-SOMREC-2024-971]. Written informed consent was obtained from all participants prior to enrolment, in accordance with the Declaration of Helsinki. Consent for publication: Not applicable Availability of data and materials: Data is available upon request. Requests should be sent to [email protected] . Conflict of interest: None to declare. Funding/Sponsorship: Self-sponsored. 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J Trauma Acute Care Surg. 2022;92(5):862–72. Hermans E, Biert J, Edwards MJR. Epidemiology of Pelvic Ring Fractures in a Level 1 Trauma Center in the Netherlands. Hip Pelvis. 2017;29(4):253–61. Zingg T, Uldry E, Omoumi P, Clerc D, Monier A, Pache B, et al. Interobserver reliability of the Tile classification system for pelvic fractures among radiologists and surgeons. Eur Radiol. 2021;31(3):1517–25. Herrera-Escobar JP, Seshadri AJ, Rivero R, Toppo A, Al Rafai SS, Scott JW, et al. Lower education and income predict worse long-term outcomes after injury. J Trauma Acute Care Surg. 2019;87(1):104–10. Brian Weatherford. Pelvic Ring Fractures. 2025. Stine S, Washington A, Sen RK, Nasr K, Vaidya R. Pelvic Malunion: A Systematic Review, Dichotomy of Definitions and Treatment. Med (Kaunas). 2022;58(8). Mishra S, Satapathy D, Zion N, Lodh U. Early Outcome Analysis of Management of Closed Pelvic Ring Fractures in Emergency: Conservative Versus Surgical at Level III Trauma Center in India. Cureus. 2022;14(6):e26195. Stephanie J. Swensen. Pelvic fractures. 2014. Kataria M, Aggarwal S, Bachhal V, Jindal K, Appajigowda A. Does the residual displacement of pelvic ring affect the functional outcome in pelvic ring injures? Int J Burns Trauma. 2023;13(2):44–50. Lee KJ, Min BW, Oh GM, Lee SW. Surgical Correction of Pelvic Malunion and Nonunion. Clin Orthop Surg. 2015;7(3):396–401. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 18 Sep, 2025 Editor invited by journal 28 Aug, 2025 Editor assigned by journal 26 Aug, 2025 Submission checks completed at journal 26 Aug, 2025 First submitted to journal 15 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Rodgers","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCklEQVRIiWNgGAWjYHACAyjNw8CQwMAgB2IeeECMFh6oFmOwlgSitQBBYgOIxKfFvL1584uPe+rk7SVyD354uMcmfX7Y4YdAW+zkdBuwa5E5c6zMcsazw4Y9EnnJEgnP0nI33k4zAGpJNjY7gF2LhESOmTHPgQOMPRI5BhIJBw7nbpydANJyIHEbPi1/DtTZA7UY/0g48D/dcHb6B0JajB8zHGBOBGoxA9pyIEFeOoeALTzHyhh7DhxO7jnzxswi4UCy4QbpnIIDCQZ4/MLevPnDjwN1tu3tOcY3fxywk5efnb75w4cKOzlcWoCATQKFawBWaYBNJRwwf0DhyjfgVT0KRsEoGAUjEAAAJJFlA8eDH4YAAAAASUVORK5CYII=","orcid":"","institution":"Makerere University","correspondingAuthor":true,"prefix":"","firstName":"Atuhaire","middleName":"","lastName":"Rodgers","suffix":""},{"id":521659248,"identity":"24d20d3c-eaa4-47a1-8d46-60ef97b70233","order_by":1,"name":"Bangirana Alexander","email":"","orcid":"","institution":"Mulago National Referral 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1","display":"","copyAsset":false,"role":"figure","size":26859,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eShort-term functional outcomes\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7381693/v1/a83e06bff0dcfafa2cc94e25.jpg"},{"id":92474551,"identity":"af926629-dddf-447a-80f8-623c8e7348f3","added_by":"auto","created_at":"2025-09-30 07:12:40","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":458025,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eRadiological displacement among the patients. EFG- Excellent, Fair, Good\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7381693/v1/f561cded728a5b9fb03508fd.jpg"},{"id":92474549,"identity":"07196163-171e-4bee-b512-4a504df0edef","added_by":"auto","created_at":"2025-09-30 07:12:40","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":26129,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eShort term radiological outcomes among the 51 patients\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7381693/v1/8485fc964c5bddbfd3e1ed61.jpg"},{"id":92479302,"identity":"bc34789e-209d-44e2-bcf7-b3ed69f5cc6a","added_by":"auto","created_at":"2025-09-30 07:36:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1503941,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7381693/v1/e8b8d188-919c-4a83-aa6b-f3c618108cc1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Short-Term Outcomes of Unstable Pelvic Fractures in Adults Treated at Mulago National Referral Hospital","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003ePelvic fractures pose a significant global health challenge, with around 4.5\u0026nbsp;million new cases and 13.1\u0026nbsp;million existing cases reported in 2021, resulting in 2.2\u0026nbsp;million years lived with disability (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The global incidence rate stands at 56.00 per 100,000 population, with Sub-Saharan Africa showing low prevalence rates (77.37 per 100,000) but increasing disease burden (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Ethiopia reports a 1.97% incidence among trauma patients, primarily affecting males (87.5%) with an average age of 31.93 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In South Africa, pelvic fractures account for approximately 16% of major trauma injuries (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), while in Uganda, unstable pelvic fractures comprise 16.7% of pelvic fracture cases (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe clinical significance of pelvic fractures extends beyond their mechanical implications, as these injuries are associated with substantial morbidity and mortality rates (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Overall mortality from pelvic fractures ranges from 4.9\u0026ndash;16%, with mortality rates significantly higher for unstable pelvic fractures, reaching 8.3% in the United States (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The high mortality is primarily attributed to life-threatening hemorrhage from retroperitoneal bleeding sources, with venous bleeding accounting for more than 90% of cases and arterial bleeding sources comprising less than 10% (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The pelvic bowl can contain approximately 1,500cc of blood, and this volume increases exponentially in mechanically unstable pelvic ring injuries, with pelvic volume increasing by 20% with a 5cm pubic symphysis disruption and up to 40% with a 10cm diastasis (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUnstable pelvic fractures, defined as those with disruption of the posterior pelvic ring structures, represent the most challenging subset of these injuries (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). According to the widely used Tile classification system, unstable fractures are classified as Type B (rotationally unstable, vertically stable) or Type C (rotationally and vertically unstable) injuries (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The Young-Burgess classification, based on injury mechanism, categorizes unstable patterns as anteroposterior compression (APC) type II/III, lateral compression (LC) type III, vertical shear (VS), and combined mechanism (CM) injuries (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). These classification systems are fundamental for treatment planning and prognostication, as they correlate with injury severity, hemorrhage risk, and clinical outcomes (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe management of unstable pelvic fractures has evolved significantly over the past decades. Contemporary treatment approaches emphasize damage control principles with early hemorrhage control, followed by definitive surgical stabilization when the patient\u0026rsquo;s physiological status permits (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Operative management has become increasingly favored over conservative treatment as it allows for earlier mobilization, reduces complications associated with prolonged recumbency, and enables correction and prevention of significant pelvic deformities, thereby improving clinical outcomes (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Treatment modalities include external fixation for emergency stabilization, followed by definitive internal fixation through various approaches including percutaneous screw fixation, open reduction and internal fixation, or combined techniques (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite advances in treatment protocols, the long-term functional and radiological outcomes of unstable pelvic fractures remain variable and are influenced by multiple factors (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Studies have reported functional outcomes using various scoring systems, with the Majeed score being the most commonly employed assessment tool (\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Excellent to good functional outcomes have been reported in 70\u0026ndash;93% of patients, though these results vary based on fracture pattern, associated injuries, and treatment methods (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Radiological outcomes are typically assessed by residual displacement, with excellent results defined as displacement of less than 5 mm (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Studies have shown that 43\u0026ndash;66% of patients achieve excellent radiological results (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSeveral factors have been identified as predictors of poor functional outcomes in patients with unstable pelvic fractures. These include advanced age, female gender, high injury severity scores, complex trauma patterns, associated injuries (particularly neurological, urogenital, and lower extremity injuries), fracture instability, and inadequate reduction (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR21 CR22\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The presence of nerve damage has been consistently identified as one of the strongest predictors of poor long-term functional outcome, with odds ratios as high as 66.9 for unsatisfactory results (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Additionally, the quality of radiological reduction appears to correlate with functional outcomes, with patients achieving excellent reduction showing superior functional performance (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRecovery patterns following unstable pelvic fractures demonstrate that most improvement occurs within the first 18 months post-injury, with patients experiencing significant reductions in health-related quality of life, particularly within the first three months (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). While continuous improvement is observed up to 12\u0026ndash;24 months, many patients do not achieve their pre-injury functional status (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The burden of these injuries extends beyond the immediate clinical impact, with studies showing that only 59\u0026ndash;77% of patients return to work and 75% achieve independent living two years post-injury (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGiven the complexity of unstable pelvic fractures and varying reported outcomes, there is need for a comprehensive evaluation of short-term functional and radiological results, especially in sub-Saharan Africa, where healthcare resources differ significantly from high-income countries. Most studies on this topic come from developed healthcare systems, limiting their relevance to resource-constrained settings (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Furthermore, there is a lack of data on short-term outcomes within the first 12 months post-injury, as many studies focus on long-term results (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study aims to determine the short-term functional and radiological outcomes of unstable pelvic fractures in adults treated at Mulago National Referral Hospital (MNRH). It will also determine the factors associated with these outcomes, thereby contributing valuable data to guide clinical decision-making and improve patient care in this challenging clinical scenario.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eAim, Study Design and Setting\u003c/h2\u003e\u003cp\u003eThis study aimed to assess the functional outcomes of patients with unstable pelvic fractures and determine the associated predictors. It also evaluated the short-term radiological outcomes of patients with unstable pelvic fractures. This was a cross-sectional study conducted from November 2024 to February 2025 at MNRH, Uganda\u0026rsquo;s largest National Referral Hospital and teaching facility for the Makerere College of Health Sciences. The study evaluated patients who sustained unstable pelvic fractures and had been previously treated at MNRH between November 2023 and April 2024.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthics Approval and Consent\u003c/h3\u003e\n\u003cp\u003e Ethical clearance was obtained from the Makerere School of Medicine Research and Ethics Committee (SOMREC), and informed consent was obtained from all participants before study enrollment.\u003c/p\u003e\n\u003ch3\u003eParticipant Selection and Eligibility Criteria\u003c/h3\u003e\n\u003cp\u003eThe study included adult patients (\u0026ge;\u0026thinsp;18 years) who sustained unstable pelvic fractures from November 2023 to April 2024, had been previously treated at MNRH, and had available prior radiological imaging. Unstable pelvic fractures were defined according to the Modified AO Tile classification, including only Tile Type B and Type C fractures.\u003c/p\u003e\u003cp\u003eExclusion criteria included patients with pathological fractures, concomitant acetabular fractures, and those who were mentally incapacitated. Patients\u0026rsquo; information was obtained from charts from the Hospital Records Registry, including their telephone numbers, and eligible participants were given appointments to attend the Orthopedic Department for assessment.\u003c/p\u003e\n\u003ch3\u003eTreatment Protocols\u003c/h3\u003e\n\u003cp\u003eFor patients managed conservatively, bed rest for 6 weeks with pelvic binders or skeletal traction was advised according to the fracture patterns. For operatively managed patients, rehabilitation was individualized based on associated injuries. Once pelvic ring stability was achieved, bedside exercises, including rolling and passive/active stretching, were initiated, followed by ambulation training using crutches or wheelchairs. All patients were advised to avoid full weight-bearing on the affected side for the initial 3 months.\u003c/p\u003e\n\u003ch3\u003eData Collection Team and Training\u003c/h3\u003e\n\u003cp\u003eThe research team consisted of the principal investigator and 2 research assistants who were qualified Orthopedic officers. The team underwent 2 weeks of training and orientation on research tool usage, with particular emphasis on completing the Majeed Pelvic Score tool. The research assistants worked under supervision during the initial part of the study until deemed proficient to work independently.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eOutcome Measurements and Variables\u003c/h2\u003e\u003cp\u003ePrimary outcome: Functional outcome was assessed using the Majeed Pelvic Score tool. Patients received an overall percentage score and were graded as excellent (\u0026gt;\u0026thinsp;85), good (70\u0026ndash;84), fair (55\u0026ndash;69), and poor (\u0026lt;\u0026thinsp;55). These categories were further classified into satisfactory (excellent or good) or unsatisfactory (fair or poor) outcomes (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eClinical assessment included detailed physical examination by the principal investigator, incorporating neurological assessment and measurement of any leg length discrepancy.\u003c/p\u003e\u003cp\u003eRadiological assessment included follow-up pelvic radiographs with anteroposterior (AP), inlet, and outlet views. Patients were requested to bring their immediate post-injury radiographs to enable pelvic fracture classification by the radiologist. Radiological parameters assessed included vertical displacement and anteroposterior displacement graded using Henderson criteria, rotational displacement graded using Lefaivre criteria, and evaluation for radiological union, non-union, symphysis diastasis, and mal-union.\u003c/p\u003e\u003cp\u003eAdditional variables collected through structured questionnaire included age, sex, marital status after injury, mechanism of injury, occupation after injury, Tile\u0026rsquo;s fracture type, treatment modality, associated injuries, and adherence to rehabilitation protocol. Data collection was conducted in Luganda and English languages.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSample Size Estimation\u003c/h3\u003e\n\u003cp\u003eThe sample size was calculated using a two-proportion formula comparing unsatisfactory functional outcomes between Tile B and Tile C pelvic fractures. The calculation assumed a 5% significance level, 80% power, and proportions of 26% and 18% unsatisfactory outcomes for Tile B and Tile C groups, respectively (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Using finite population correction for the study population and adjusting for a 20% non-response rate, a final sample size of 51 patients was determined and enrolled.\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using STATA version 15. Continuous variables were summarized as medians with interquartile ranges, while categorical variables were presented as frequencies and proportions. At bivariate analysis, a modified Poisson regression model was applied, and variables with p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant. Variables with p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.2 at bivariate analysis were included in the multivariate model, where p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant predictors of functional outcomes. Stepwise regression and correlation analysis were performed to control for confounding, with correlation coefficients\u0026thinsp;\u0026lt;\u0026thinsp;0.4 deemed acceptable to minimize multicollinearity. For short-term radiological outcomes, associations between radiological union and either functional outcome or fracture type were evaluated using Fischer\u0026rsquo;s exact test when cell counts were \u0026le;\u0026thinsp;5, and the Chi-square test when counts were \u0026gt;\u0026thinsp;5.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe median age was 31 years (IQR: 25\u0026ndash;38), with males comprising 56.9% (n\u0026thinsp;=\u0026thinsp;29) of the cohort. Type B fractures were the most common, accounting for 60.8% (n\u0026thinsp;=\u0026thinsp;31) of cases. The majority of patients underwent surgical treatment (54.9%, n\u0026thinsp;=\u0026thinsp;28), while only 11.8% (n\u0026thinsp;=\u0026thinsp;6) did not adhere to the rehabilitation protocol. Sociodemographic and clinical characteristics are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic and clinical characteristics of patients with unstable pelvic fractures.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency (n)/Median (IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupational Status after Injury\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo occupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave occupation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMechanism of Pelvic Injury\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRoad traffic accident\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFall from height\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFracture Type\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType B\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eType C\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAssociated Injuries\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtra-skeletal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSkeletal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFracture Management Approach\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-operative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLeg Length Discrepancy\u0026thinsp;\u0026gt;\u0026thinsp;2 cm\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e56.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHaving Nerve Damage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRehabilitation Protocol Followed\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eShort-term functional outcomes.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOverall, 57% (n\u0026thinsp;=\u0026thinsp;29) of patients achieved satisfactory functional outcomes (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), with 64.5% (n\u0026thinsp;=\u0026thinsp;20) of Type B and 45% (n\u0026thinsp;=\u0026thinsp;9) of Type C fractures reaching this outcome.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eShort-term radiological outcomes.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAmong the 51 patients, 11% (n\u0026thinsp;=\u0026thinsp;6) exhibited poor vertical displacement, 31% (n\u0026thinsp;=\u0026thinsp;20) had poor rotational displacement, and 7.8% (n\u0026thinsp;=\u0026thinsp;4) showed poor anteroposterior displacement (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Analysis of radiological displacement in relation to fracture type, management modality, and functional outcomes revealed that fracture type (Tile B vs. C) was significantly associated with vertical displacement (p\u0026thinsp;=\u0026thinsp;0.002), while functional outcome correlated significantly with anteroposterior displacement (p\u0026thinsp;=\u0026thinsp;0.029). (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAdditionally, 22% (n\u0026thinsp;=\u0026thinsp;11) of patients demonstrated non-union on radiological assessment (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). There was no significant association between radiological union and functional outcome or fracture type.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFactors associated with short-term functional outcomes.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn the bivariate analysis, marital status, education level, leg length discrepancy, nerve damage, and fracture management were significantly associated with worse outcomes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). These significant variables, together with associated injuries and fracture type (p\u0026thinsp;\u0026lt;\u0026thinsp;0.2), were considered for the multivariate model. Following stepwise regression and correlation checks to control for multicollinearity, only nerve damage, education level, and fracture management remained in the final multivariate model, and all were statistically significant.\u003c/p\u003e\u003cp\u003eParticipants with primary education were 23% more likely to have unsatisfactory outcomes compared to those with secondary education (APR\u0026thinsp;=\u0026thinsp;1.23, 95% CI: 1.03\u0026ndash;1.46, p\u0026thinsp;=\u0026thinsp;0.023). Those with nerve damage were 31% more likely to experience unsatisfactory outcomes than those without (APR\u0026thinsp;=\u0026thinsp;1.31, 95% CI: 1.09\u0026ndash;1.59, p\u0026thinsp;=\u0026thinsp;0.005). Similarly, patients managed non-operatively were 24% more likely to have unsatisfactory outcomes compared to those managed operatively (APR\u0026thinsp;=\u0026thinsp;1.24, 95% CI: 1.05\u0026ndash;1.46, p\u0026thinsp;=\u0026thinsp;0.011)(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMultivariate analysis of factors associated with functional outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnsatisfactory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSatisfactory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAPR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e17(73.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6(26.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTertiary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5(71.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.23(0.96\u0026ndash;1.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.104\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10(47.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11(52.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.23(1.03\u0026ndash;1.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.023\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNerve damage\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27(67.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13(32.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2(9.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19(90.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.31(1.09\u0026ndash;1.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFracture management\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOperatively\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21(75.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-operatively\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8(34.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15(65.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.24(1.05\u0026ndash;1.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe study shows that a high proportion (43.1%) of patients had unsatisfactory short-term functional outcomes following treatment of unstable pelvic fractures. This could be explained by the lack of adherence to post-management instructions by the patients and the conservative management of some unstable pelvic fractures (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Another reason for the relatively high number of unsatisfactory outcomes may be due to our study\u0026rsquo;s relatively shorter patient follow-up. It has been reported that patients with longer than 5 years of follow-up had better outcomes than those followed up for one year (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). This finding is consistent with studies by Kokubo, Oki (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and Nana, Ngo-Yamben (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) which observed 36.6% and 42% unsatisfactory functional outcomes, respectively. However, this is in contrast to findings by Verma et al, in India among patients with unstable pelvic fractures, who observed that 27% of the patients had unsatisfactory functional outcomes (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). This could be attributed to the fact that their sample size was larger (n\u0026thinsp;=\u0026thinsp;112) compared to our study (n\u0026thinsp;=\u0026thinsp;51), and their study design was a cohort, whereas ours was cross-sectional.\u003c/p\u003e\u003cp\u003eOur study also showed that 60.8% sustained Tile Type B pelvic fractures, while a smaller proportion had Type C injuries. This predominance likely reflects common injury mechanics like lateral compression and open-book mechanisms that lead to rotationally unstable but vertically stable fractures (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Similar findings have been reported elsewhere; for instance, a Swiss multicenter study noted Type B fractures accounted for 54% of pelvic ring injuries, while Type C comprised 28% (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Another study by the Dutch series showed Type B fractures at 39.3% and Type C at 35.2% (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). In contrast, other studies report varying proportions; for instance, in a recent reliability study of Tile classification, Type C fractures were actually more common (43%) than Type B (34%) among 238 cases (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Such divergence could be due to differences in patient population, referral pathways, or the nature of the healthcare setting, tertiary trauma centers may see a different spectrum of severity, and classification biases or imaging practices may also play a role (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDemographically, we identified a lower education level as a risk factor: participants with only a primary education were 23% more likely to experience unsatisfactory outcomes. This finding represents a novel contribution to the pelvic trauma literature, as education level has not been extensively studied as a prognostic factor in this population. This association likely reflects various underlying mechanisms, including health literacy, treatment compliance, and socioeconomic factors that influence access to rehabilitation and outcomes (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Generally, higher education is associated with a better understanding of treatment protocols, adherence to physiotherapy, and earlier recognition of complications, all of which contribute to improved functional recovery (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e\u003cp\u003ePatients with neurological injuries also demonstrated poorer function; those with nerve damage were 31% more likely to have unsatisfactory outcomes. Nerve injuries, such as lumbosacral plexus or sacral nerve root lesions, can result in persistent motor or sensory deficits and chronic pain, directly impairing function (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). This is consistent with prior reports that neurological deficits following pelvic trauma predict a poor recovery. For instance, Ghosh, Aggarwal (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) identified associated nerve injuries as significantly linked to poorer functional scores, and Brian Weatherford (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) notes that neurological injuries are known predictors of adverse outcomes in pelvic fractures.\u003c/p\u003e\u003cp\u003eWe found that non-operative management was associated with poorer outcomes: patients who did not undergo surgery were 24% more likely to have unsatisfactory results. This supports the established consensus that unstable pelvic injuries often benefit from surgical fixation, which facilitates stabilization, restores alignment, and enables early mobilization, key factors in improving functional recovery (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Historical data reinforce this, showing that non-operative approaches such as prolonged bed rest, casting, or external fixation may lead to malunion in up to 80% of cases, particularly when used for unstable pelvic fractures (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Supporting our study, Kokubo, Oki (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) identified conservative treatment as a strong independent predictor of poor short-term functional outcomes in unstable pelvic ring fractures, reporting an odds ratio of approximately 13.7 for unsatisfactory results compared to operative treatment. However, not all evidence aligns uniformly. For example, a recent randomized pilot trial in elderly patients with low-energy posterior pelvic (FFP II) fractures found no significant difference in functional outcomes between conservative and surgical groups at one year (measured by pain, mobility, quality of life, or mortality) (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). This discrepancy likely stems from differences in patient populations (frail elderly with low-energy injuries amenable to conservative management) and follow-up duration, which in their study was longer and focused on stable or minimally displaced fractures.\u003c/p\u003e\u003cp\u003eOn radiographs, we observed that 11% of patients had poor vertical alignment, 31% had poor rotational alignment, and 7.8% had poor anteroposterior (AP) alignment. Rotational malalignment was the most common issue in our series, perhaps due to the technical challenges of correcting pelvic ring twist (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). As expected, vertical displacement strongly correlated with fracture type (p\u0026thinsp;=\u0026thinsp;0.002): vertically unstable (Tile C) injuries typically result in cranial-caudal asymmetry of the hemipelvis. Significant vertical offset is known to have functional consequences; for example, uncorrected superior migration greater than 2 cm can lead to leg length discrepancies and gait disturbances (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). We also found that worse AP displacement (indicating symphyseal or sacroiliac joint diastasis) was significantly correlated with poorer functional outcomes (p\u0026thinsp;=\u0026thinsp;0.029). This is logical, as AP displacement often indicates sacroiliac joint incongruity; indeed, pelvic injury reviews identify sacroiliac joint displacement greater than 1 cm as a risk factor for chronic pain and disability (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Thus, our data suggest that even subtle malalignments in the anterior-posterior direction may more directly impact early mobility. In contrast, some authors have reported that small residual displacements (up to approximately 1 cm) do not necessarily worsen short-term Majeed scores (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). The differing findings likely arise from the thresholds chosen and individual patient factors, but overall, our evidence supports that gross malalignment (in any plane) is detrimental.\u003c/p\u003e\u003cp\u003eWe observed that 22% of patients exhibited radiographic evidence of non-union at short-term follow-up. This rate is significantly higher than the approximately 5% non-union rate typically reported in broader studies (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). This discrepancy likely arises from our strict radiographic criteria and the relatively early follow-up period; incomplete healing at 6\u0026ndash;8 months can be interpreted as \u0026ldquo;non-union\u0026rdquo; on X-rays, even if eventual healing does occur.\u003c/p\u003e\u003cp\u003eImportantly, unlike vertical or rotational displacement, radiological non-union was not significantly associated with fracture type or functional status in our study. This indicates that, in the short term, factors such as malalignment and neurologic injury are more critical to functional outcomes than delayed bone healing, which may take longer to become symptomatic (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). The published literature on early non-union rates in pelvic fractures is limited; however, it is well known that persistent instability (nonunion or malunion) can ultimately lead to pain and disability, highlighting the importance of follow-up (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur study has some limitations. A central limitation of this study is its cross-sectional design, which offers a snapshot of outcomes at a single time point, thereby precluding any assessment of causality or temporal progression of functional and radiological recovery. To overcome this, future studies could adopt longitudinal or repeated cross-sectional designs, allowing researchers to track trajectory changes over time and better infer cause-and-effect relationships. The sample size, 51 patients, though calculated using finite population correction and a 20% non-response buffer, still limits statistical power to detect smaller but clinically relevant associations; future studies could aim for larger, multi-center cohorts, incorporating pre-study power analyses to ensure adequate effect detection. Finally, the study assessed only short-term outcomes, limiting our understanding of long-term functional status and radiological progression; this could be addressed through extended follow-up, such as beyond 6\u0026ndash;12 months, to capture recovery trajectories, late complications, and long-term union rates.\u003c/p\u003e\u003cp\u003eDespite these limitations, our findings underscore important determinants of outcomes in pelvic fractures: roughly half of the patients recover well by early follow-up; however, the risk of poor outcomes is higher among those with lower education levels, neurological injuries, or those who receive nonoperative management. Properly aligning fractures, particularly correcting rotational deformity and sacroiliac joint incongruity, may enhance function. Future prospective, multi-center studies with longer follow-up periods are necessary to confirm these predictors and improve management strategies to optimize recovery from pelvic fractures.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eNearly half of patients with unstable pelvic fractures at Uganda\u0026rsquo;s main trauma referral center experience unsatisfactory short-term functional outcomes, with lower education level, neurological injury, and non-operative management emerging as key predictors of poor recovery. Radiological findings further emphasize that malalignment, particularly in the anteroposterior plane, has a stronger early functional impact than delayed union. These results underscore the importance of patient education, timely surgical stabilization where indicated, and meticulous attention to fracture alignment in optimizing recovery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eArbeitsgemeinschaft f\u0026uuml;r Osteosynthesefragen (Association for the Study of Internal Fixation)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAnteroposterior\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAPC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAnteroposterior Compression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAPR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAdjusted Prevalence Ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eConfidence Interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eCombined Mechanism\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInterquartile Range\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLateral Compression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMNRH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMulago National Referral Hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSOMREC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSchool of Medicine Research and Ethics Committee\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eVertical Shear\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Makerere School of Medicine Research and Ethics Committee (SOMREC), reference number [Mak-SOMREC-2024-971]. Written informed consent was obtained from all participants prior to enrolment, in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eData is available upon request. Requests should be sent to [email protected].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eNone to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding/Sponsorship:\u0026nbsp;\u003c/strong\u003eSelf-sponsored.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u0026nbsp;\u003c/strong\u003enot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors (AR, BA, MJM, NR) significantly contributed to the conceptualization, data collection, data analysis and interpretation, drafting, and final approval of\u0026nbsp;the\u0026nbsp;manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to acknowledge the contribution of all authors and co-authors, as well as the research assistants and the biostatistician for their valuable input throughout the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWei J, He D, Lan G, Xu M, Guo J, Lan Y, Zong S. Global, regional, and national burden of fracture of pelvis, 1990\u0026ndash;2021: analysis of data from the Global Burden of Disease Study 2021. Front Public Health. 2025;13:1610604.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi C, Lin Q. Global Epidemiology, Burden, and Causes of Lower Extremity and Pelvic Fractures in the Past 32 Years. Front Public Health.13:1627867.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFerede B, Ayenew A, Belay W. Pelvic Fractures and Associated Injuries in Patients Admitted to and Treated at Emergency Department of Tibebe Ghion Specialized Hospital, Bahir Dar University, Ethiopia. Orthop Res Rev. 2021;13:73\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSobantu NA, Tshabalala MD, Chetty V. Exploring the collaborative care of patients with pelvic fractures in Tshwane, South Africa. S Afr Fam Pract (2004). 2023;65(1):e1-e9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOsuta HM. Short term poor outcome determinants of patients with traumatic pelvic fractures: Across-sectional study at three private not for profit hospitals of Nsambya. Lubaga and Mengo: Uganda Martyrs University; 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMardanpour K. Incidence of pelvic trauma and relative risk factors for mortality: a population based study in Iran. 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdelrahman H, El-Menyar A, Keil H, Alhammoud A, Ghouri SI, Babikir E, et al. Patterns, management, and outcomes of traumatic pelvic fracture: insights from a multicenter study. J Orthop Surg Res. 2020;15(1):249.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHu S, Guo J, Zhu B, Dong Y, Li F. Epidemiology and burden of pelvic fractures: Results from the Global Burden of Disease Study 2019. Injury. 2023;54(2):589\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStahel PF, Ziran N. The pathophysiology of pelvic ring injuries: a review. Patient Saf Surg. 2024;18(1):16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim WY. Treatment of Unstable Pelvic Ring Injuries. Hip Pelvis. 2014;26(2):79\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKlingebiel FK-L, Hasegawa M, Parry J, Balogh ZJ, Sen RK, Kalbas Y, et al. Standard practice in the treatment of unstable pelvic ring injuries: an international survey. Int Orthop. 2023;47(9):2301\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNickson C. Classification of Pelvic Fractures. 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLu S, Liu F, Xu W, Zhou X, Li L, Zhou D et al. Management of open tile C pelvic fractures and their outcomes: a retrospective study of 30 cases. Ther Clin Risk Manag. 2022:929\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGeorge VR. Jr. Pelvic Fractures Treatment \u0026amp; Management. 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAyvaz M, Caglar O, Yılmaz G, Guvendik Gİ, Acaroğlu RE. Long-term outcome and quality of life of patients with unstable pelvic fractures treated by closed reduction and percutaneous fixation. Turkish J trauma Emerg Surg. 2011;17(3):261\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRavi Malhotra. Functional and radiological outcome of operative treatment for unstable pelvic ring fractures: A 2 year prospective observational study. 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrouwers L, de Jongh MAC, de Munter L, Edwards M, Lansink KWW. Prognostic factors and quality of life after pelvic fractures. The Brabant Injury Outcome Surveillance (BIOS) study. PLoS ONE. 2020;15(6):e0233690.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGhosh S, Aggarwal S, Kumar P, Kumar V. Functional outcomes in pelvic fractures and the factors affecting them- A short term, prospective observational study at a tertiary care hospital. J Clin Orthop Trauma. 2019;10(5):896\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eG\u0026auml;nsslen A, Lindahl J, Krappinger D, Lindtner RA, Staresinic M. Outcome of pelvic ring injuries. Arch Orthop Trauma Surg. 2024;145(1):47.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElhence A, Netaji J, Yadav SK, Rajnish RK, Gupta S. Functional outcome and analysis of factors affecting health-related quality of life of surgically managed pelvic ring fractures: a cross-sectional study. Eur J Orthop Surg Traumatol. 2024;34(4):1917\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKokubo Y, Oki H, Sugita D, Takeno K, Miyazaki T, Negoro K, Nakajima H. Functional outcome of patients with unstable pelvic ring fracture:Comparison of short- and long-term prognostic factors. J Orthop Surg. 2017;25(1):2309499016684322.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOoi CK, Goh HK, Tay SY, Phua DH. Patients with pelvic fracture: what factors are associated with mortality? Int J Emerg Med. 2010;3(4):299\u0026ndash;304.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHolstein JH, Pizanis A, K\u0026ouml;hler D, Pohlemann T. What are predictors for patients' quality of life after pelvic ring fractures? Clin Orthop Relat Res. 2013;471(9):2841\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYu Y-H, Hsu Y-H, Chou Y-C, Liu C-H, Tseng IC, Chen IJ. Three-year functional outcome after open pelvic fracture treatment: a retrospective case series from a level I trauma center. Eur J Orthop Surg Traumatol. 2023;33(4):937\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKokubo Y, Oki H, Sugita D, Takeno K, Miyazaki T, Negoro K, Nakajima H. Functional outcome of patients with unstable pelvic ring fracture: Comparison of short-and long-term prognostic factors. J Orthop Surg. 2017;25(1):2309499016684322.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNana CT, Ngo-Yamben M, Fokam P, Mahamat A, Bombah F, Boukar ME, et al. Functional outcome of unstable pelvic fractures treated in a level III hospital in a developing country: a 10-year prospective observational study. J Orthop Surg Res. 2022;17(1):198.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVerma V, Sen RK, Tripathy SK, Aggarwal S, Sharma S. Factors affecting quality of life after pelvic fracture. J Clin Orthop trauma. 2020;11(6):1016\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStine S, Washington A, Sen RK, Nasr K, Vaidya R. Pelvic Malunion: A Systematic Review, Dichotomy of Definitions and Treatment. Medicina. 2022;58(8):1098.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVilliger K, Meier MK, Hasler RM, Bastian JD, Tannast M, Exadaktylos AK, Steppacher SD. Demographic changes in pelvic fracture patterns at a Swiss academic trauma center from 2007 to 2017. J Trauma Acute Care Surg. 2022;92(5):862\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHermans E, Biert J, Edwards MJR. Epidemiology of Pelvic Ring Fractures in a Level 1 Trauma Center in the Netherlands. Hip Pelvis. 2017;29(4):253\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZingg T, Uldry E, Omoumi P, Clerc D, Monier A, Pache B, et al. Interobserver reliability of the Tile classification system for pelvic fractures among radiologists and surgeons. Eur Radiol. 2021;31(3):1517\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHerrera-Escobar JP, Seshadri AJ, Rivero R, Toppo A, Al Rafai SS, Scott JW, et al. Lower education and income predict worse long-term outcomes after injury. J Trauma Acute Care Surg. 2019;87(1):104\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrian Weatherford. Pelvic Ring Fractures. 2025.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStine S, Washington A, Sen RK, Nasr K, Vaidya R. Pelvic Malunion: A Systematic Review, Dichotomy of Definitions and Treatment. Med (Kaunas). 2022;58(8).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMishra S, Satapathy D, Zion N, Lodh U. Early Outcome Analysis of Management of Closed Pelvic Ring Fractures in Emergency: Conservative Versus Surgical at Level III Trauma Center in India. Cureus. 2022;14(6):e26195.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStephanie J. Swensen. Pelvic fractures. 2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKataria M, Aggarwal S, Bachhal V, Jindal K, Appajigowda A. Does the residual displacement of pelvic ring affect the functional outcome in pelvic ring injures? Int J Burns Trauma. 2023;13(2):44\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee KJ, Min BW, Oh GM, Lee SW. Surgical Correction of Pelvic Malunion and Nonunion. Clin Orthop Surg. 2015;7(3):396\u0026ndash;401.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Unstable pelvic fractures, short-term outcomes, Majeed Pelvic score","lastPublishedDoi":"10.21203/rs.3.rs-7381693/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7381693/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePelvic fractures are a significant health issue, with over 4.5\u0026nbsp;million new cases annually and high morbidity and mortality. Unstable pelvic fractures, affecting the posterior pelvic ring, pose severe hemorrhage risks and poor outcomes. Classification systems like Tile and Young-Burgess aid in management. Current treatment emphasizes early hemorrhage control and surgical stabilization for better recovery. Functional outcomes, measured with the Majeed score, depend on injury severity and care quality. Given the limited research on short-term outcomes in sub-Saharan Africa, this study aims to evaluate the short-term radiological and functional outcomes, as well as predictors of functional outcomes of unstable pelvic fractures in adults at Mulago National Referral Hospital.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA cross-sectional study was conducted on 51 patients who met the inclusion criteria. Functional outcomes were assessed using the Majeed Pelvic score, while Radiological outcomes were evaluated for bony union, non-union, and malunion. Data was collected using a structured questionnaire and analyzed using STATA version 15.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe median age was 31 (IQR 25,38), and the male sex dominated 56.9% (n\u0026thinsp;=\u0026thinsp;29). A satisfactory functional outcome was observed among 57% (n\u0026thinsp;=\u0026thinsp;29) of the patients. Radiological union occurred among 78% (n\u0026thinsp;=\u0026thinsp;40) of the patients. Significant predictors of unsatisfactory outcomes were primary (APR\u0026thinsp;=\u0026thinsp;1.23, 95% CI: 1.03\u0026ndash;1.46, p\u0026thinsp;=\u0026thinsp;0.023), nerve damage (APR\u0026thinsp;=\u0026thinsp;1.31, 95% CI: 1.09\u0026ndash;1.59, p\u0026thinsp;=\u0026thinsp;0.005), and fracture management (APR\u0026thinsp;=\u0026thinsp;1.24, 95% CI: 1.05\u0026ndash;1.46, p\u0026thinsp;=\u0026thinsp;0.011).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eNearly half of patients with unstable pelvic fractures in Uganda experience unsatisfactory short-term functional outcomes, with low education, nerve injury, and non-operative management as key predictors. Early anteroposterior malalignment also significantly affects function, highlighting the need for patient education and timely, precise surgical care\u003c/p\u003e","manuscriptTitle":"Short-Term Outcomes of Unstable Pelvic Fractures in Adults Treated at Mulago National Referral Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 07:12:35","doi":"10.21203/rs.3.rs-7381693/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-09-18T04:42:31+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-28T06:46:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-26T06:52:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-26T06:50:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-08-15T13:21:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"767f7504-fdd8-45b8-b6c1-dd17e4fb9124","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-30T07:12:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-30 07:12:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7381693","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7381693","identity":"rs-7381693","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}