Surgical Management of Unstable Pelvic Fractures in Yemen: A Prospective Cohort Study of Functional Outcomes and Complications

Abstract

Background: Unstable pelvic fractures are severe injuries resulting from high-energy trauma that often led to significant morbidity and mortality. Surgical management aims to restore stability and improve functional outcomes; however, data from conflict-affected regions such as Yemen are scarce. This study aimed to prospectively evaluate the functional outcomes and complications of the surgical management of unstable pelvic fractures in a Yemeni patient cohort.

Methods: This prospective cohort study was conducted at the Military General Hospital and Al-Thawra Modern General Hospital in Sana’a, Yemen, between April 2019 and April 2023. We enrolled 76 patients aged 16– 60 years with unstable pelvic ring fractures that required surgical intervention (Tile type B/C). Data on patient demographics, mechanism of injury, fracture classification (Tile and Young-Burgess), surgical approach, and complications were collected and analyzed. Anatomical reduction was assessed using the Matta and Tornetta criteria, respectively. Functional outcomes were evaluated using the Majeed scoring system at a mean follow-up of four years.

Results: The mean patient age was 34 years, and the majority of patients were male (68.4%). The most frequent mechanisms of injury were motorcycle accidents (30.3%) and car accidents (27.6%), followed by falls from a height (26.3%). According to the Tile classification, the most frequent fracture patterns were C2 (36.8%) and C1 (34.2%). Postoperative radiological assessment revealed excellent reduction in 69.7% of patients. The overall complication rate was 30.3%, with wound infections (9.2%) being the most common. According to the Majeed Functional Outcome Score, 63.2% of the patients achieved excellent results. Statistical analysis revealed a significant positive correlation between the quality of radiological reduction and final functional outcomes (p < 0.05).

Conclusion: Surgical management of unstable pelvic fractures in the challenging setting of Yemen can yield good-to-excellent functional outcomes. Despite resource limitations, anatomical reduction and stable fixation lead to satisfactory results, although complication rates remain a concern. This study highlights the feasibility
and effectiveness of modern orthopedic trauma care in conflict zones.