Predictors of long-term quality of life following operative treatment of unstable pelvic ring injuries: A retrospective cohort study.

OBJECTIVES: To evaluate long-term health-related quality of life after operative treatment of unstable pelvic ring injuries and determine factors independently associated with outcome. METHODS: A retrospective cohort study was conducted at a single Level I trauma center. Adult patients with AO/OTA 61B and 61 C pelvic ring injuries treated operatively between 2014 and 2018 with a minimum follow-up of five years were included. Health-related quality of life was assessed using the EQ-5D-5L (Indian value set). Associations between patient, injury, and treatment characteristics and EQ-5D index scores were evaluated using univariable and multivariable linear regression. RESULTS: Ninety-eight patients were included (74% male; mean age, 41 ± 15 years) with a mean follow-up of 6.7 years. The mean EQ-5D index score was 0.87 ± 0.13. On univariable analysis, poor reduction, polytrauma, concomitant injuries, and postoperative complications were associated with lower EQ-5D scores, whereas combined and posterior fixation were associated with higher scores. On multivariable analysis, poor reduction (>10 mm; β = -0.22, 95% CI -0.29 to -0.15; p < 0.001) and polytrauma (β = -0.05, 95% CI -0.09-0.00; p = 0.044) remained independently associated with worse quality of life. Fixation method and AO/OTA fracture classification were not independently associated with outcome. CONCLUSIONS: Poor reduction and polytrauma were independently associated with worse long-term quality of life after operative treatment of unstable pelvic ring injuries. Reduction quality was the only potentially modifiable factor independently associated with long-term outcome, supporting careful attention to fracture reduction during operative management. LEVEL OF EVIDENCE: Prognostic Level IV. LEVEL OF EVIDENCE: IV. LEVEL OF CLINICAL CARE: Level I Tertiary trauma centre.