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Introduction <p>Floating-hip fractures (FHF) pose substantial management challenges, characterized by high acute-phase mortality, suboptimal hip function outcomes, and a lack of standardized treatment protocols. This study aims to evaluate the efficacy and safety of a novel hybrid pelvo-femoral external fixation (HPFEF) for simultaneous pelvic-femoral stabilization, highlighting its advantages over traditional pelvic external fixation combined with skeletal traction (PEFST).</p> Material and Methods <p>A retrospective propensity score-matched (PSM) analysis was conducted at a Level-I trauma center (January 2015–December 2022), enrolling 68 FHF patients (HPFEF: n = 34; PEFST: n = 34). PSM balanced baseline confounders (age, injury severity score [ISS], fracture type, injury mechanism, preoperative lactate, Charlson Comorbidity Index [CCI]) to minimize bias. Outcomes included demographics, initial surgical details, VAS scores [<CitationRef CitationID="CR15">15</CitationRef>], fracture reduction degree (FRD), definitive surgery duration, bed rest time/fracture-related complications, Majeed scores, Harris Hip Score (HHS) and mortality. Multivariable logistic regression (30-day mortality, 6-month return to activities; adjusted for ISS, lactate, CCI) and linear regression (FRD, HHS; adjusted for fracture type, injury mechanism, surgery duration) were performed.</p> Results <p>Compared with PEFST, the HPFEF group demonstrated significantly superior FRD (6.2 ± 2.8 vs. 13.8 ± 7.1), greater VAS reduction (3.6 ± 0.4 vs. 1.9 ± 0.8), and a lower pressure ulcer rate (2.9% vs. 14.7%). Shorter definitive surgery duration was also found in the HPFEF group than in the PEFST group (44.8 ± 6.9 vs. 53.2 ± 8.7), along with less lower limb shortening (0.5 ± 0.2 vs. 0.8 ± 0.3) on radiological assessment. HPFEF also yielded higher 12-month Majeed scores (84.9 ± 6.7 vs. 72.1 ± 8.3), HHS (85.7 ± 5.9 vs. 71.9 ± 8.5), a higher rate of return to pre-injury activities (82.4% vs. 52.9%), and better performance in 30-day mortality. Multivariable linear regression verified HPFEF’s independent association with favorable fracture reduction outcomes.</p> Conclusion <p>For the acute management of FHF, HPFEF is safer and more effective than PEFST in maintaining fracture alignment, facilitating nursing care, and enabling definitive surgical intervention. Aligned with damage control orthopedics (DCO) principles, HPFEF is associated with improved functional outcomes and reduced mortality, a finding that may support its potential utility as a preferred acute management option for patients with FHF.</p>

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Hybrid Pelvo-femur External Fixation Versus Pelvic External Fixation Combined with Skeletal Traction for Floating-Hip Fractures: A Propensity Score-matched Study on Reduction Efficacy and Postoperative Safety

  • 期刊论文

  • 发表日期：

    2026年7月16日

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  • Qing Yang,
  • Jianghan Xu,
  • Gengqi Wang,
  • Xingguang Tao,
  • Qiugen Wang

摘要

Introduction

Floating-hip fractures (FHF) pose substantial management challenges, characterized by high acute-phase mortality, suboptimal hip function outcomes, and a lack of standardized treatment protocols. This study aims to evaluate the efficacy and safety of a novel hybrid pelvo-femoral external fixation (HPFEF) for simultaneous pelvic-femoral stabilization, highlighting its advantages over traditional pelvic external fixation combined with skeletal traction (PEFST).

Material and Methods

A retrospective propensity score-matched (PSM) analysis was conducted at a Level-I trauma center (January 2015–December 2022), enrolling 68 FHF patients (HPFEF: n = 34; PEFST: n = 34). PSM balanced baseline confounders (age, injury severity score [ISS], fracture type, injury mechanism, preoperative lactate, Charlson Comorbidity Index [CCI]) to minimize bias. Outcomes included demographics, initial surgical details, VAS scores [15], fracture reduction degree (FRD), definitive surgery duration, bed rest time/fracture-related complications, Majeed scores, Harris Hip Score (HHS) and mortality. Multivariable logistic regression (30-day mortality, 6-month return to activities; adjusted for ISS, lactate, CCI) and linear regression (FRD, HHS; adjusted for fracture type, injury mechanism, surgery duration) were performed.

Results

Compared with PEFST, the HPFEF group demonstrated significantly superior FRD (6.2 ± 2.8 vs. 13.8 ± 7.1), greater VAS reduction (3.6 ± 0.4 vs. 1.9 ± 0.8), and a lower pressure ulcer rate (2.9% vs. 14.7%). Shorter definitive surgery duration was also found in the HPFEF group than in the PEFST group (44.8 ± 6.9 vs. 53.2 ± 8.7), along with less lower limb shortening (0.5 ± 0.2 vs. 0.8 ± 0.3) on radiological assessment. HPFEF also yielded higher 12-month Majeed scores (84.9 ± 6.7 vs. 72.1 ± 8.3), HHS (85.7 ± 5.9 vs. 71.9 ± 8.5), a higher rate of return to pre-injury activities (82.4% vs. 52.9%), and better performance in 30-day mortality. Multivariable linear regression verified HPFEF’s independent association with favorable fracture reduction outcomes.

Conclusion

For the acute management of FHF, HPFEF is safer and more effective than PEFST in maintaining fracture alignment, facilitating nursing care, and enabling definitive surgical intervention. Aligned with damage control orthopedics (DCO) principles, HPFEF is associated with improved functional outcomes and reduced mortality, a finding that may support its potential utility as a preferred acute management option for patients with FHF.