title: APC Injuries With Symphyseal Fixation: What Affects Outcome?
abstract: OBJECTIVE
  To evaluate the influence of the symphyseal position at union, implant failure, and the type of posterior ring injury on validated outcome measures.
  
  
  METHODS
  Retrospective review with prospectively collected validated outcome data.
  
  
  METHODS
  Two academic level 1 trauma centers.
  
  
  METHODS
  We evaluated 54 patients with operatively treated anterior-posterior compression (APC) type 2 and 3 injuries.
  
  
  METHODS
  Thirty-five APC type 2 and 19 APC type 3 injuries were reviewed at a minimum of 2 years after surgery. Average follow-up was 7 years.
  
  
  METHODS
  Patients were evaluated with validated EuroQol five dimensions (EQ5D), EuroQol health index, Visual Analog Score (VAS) pain, Majeed pelvic scores, and change in work status. The final anterior-posterior (AP) radiograph available was reviewed for implant failure and displacement. Revision surgery was documented based on implant status and displacement at final follow-up.
  
  
  RESULTS
  There were trends toward better outcomes for APC type 2 for EQ5D and VAS pain. Patients with injury severity score (ISS) >16 had worse reported health, Majeed scores, and VAS pain. Nineteen patients had failure of fixation. There were no differences in any outcome measure; trends toward better Majeed score were found for patients with intact fixation. Displacements >15 mm anteriorly at final follow-up negatively affect outcomes with significantly worse EQ5D, reported health, and Majeed score. Two patients required revision surgery. There were no differences in final outcomes.
  
  
  CONCLUSIONS
  No significant differences were found for APC type 2 versus type 3 injuries. Higher injury severity score resulted in worse outcomes and more pain. Outcomes were not effected by implant failure; however, major loss of reduction (>15 mm) anteriorly did negatively impact outcomes. Patients with failure who were revised to union did not have worse outcomes.
  
  
  METHODS
  Prognostic level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedics, Boston University Medical Center, Boston, MA; and †Department of Orthopaedics, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: Kyle
authors.initials: K
authors.lastname: Lybrand
authors.forename: Anthony
authors.initials: A
authors.lastname: Bell
authors.forename: Deirdre
authors.initials: D
authors.lastname: Rodericks
authors.forename: David
authors.initials: D
authors.lastname: Templeman
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis* / Q000601:surgery*; D050815:Fractures, Compression / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D008910:Minnesota; D011475:Prosthesis Failure; D011631:Pubic Symphysis / Q000293:injuries* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult