Minimal-invasive stabilization of anterior pelvic ring fractures with retrograde transpubic screws

•Retrograde transpubic screw osteosynthesis is increasingly accepted due to its minimal invasive technique and adequate stability.•The results of 158 retrograde transpubic screw osteosyntheses in 128 patients are presented. /6 procedures were performed in patients with fragility fractures of the pelvis.•There were no vascular, neurological or urological complications. 90.3% of fractures (n = =75) with a follow-up of ≥6months showed radiographic evidence of healing.•Nonunion rate was not dependent on the quality of primary reduction, secondary displacement, or screw loosening.•Retrograde transpubic screw is a reliable minimal-invasive osteosynthesis to stabilize the anterior pelvic ring, also in fragility fracture of the pelvis. In the vast majority of patients with pelvic ring lesions, there is a combination of fractures of the posterior and anterior pelvic ring. Anterior fractures are painful and contribute to loss of stability of the pelvic ring. For these reasons, stabilization of pubic rami fractures is recommended together with posterior pelvic ring fixation. Retrograde transpubic screw osteosynthesis enjoys increasing acceptance due to its minimal invasive technique and adequate stability. We retrospectively reviewed the results of 158 retrograde transpubic screw osteosyntheses in 128 patients with pelvic ring lesions including a pubic ramus fracture. Sixty-three patients suffered a high-energy injury, 65 a fragility fracture of the pelvis. One hundred and forty-six screws (92.4%) were inserted through a percutaneous procedure. There were no vascular, neurological or urological complications. Fifty-nine screws (39%) yielded an excellent reduction with less than one cortical width of displacement. Slight secondary displacement was seen in 33 of these fractures (55.9%). Early surgical complications were seen in 16 screws (10.1%): suboptimal pathway in 10, local hematoma in 4 and local infection in 3. Early revision surgery was done in 7 screws (4.4%). Median follow-up was 27.6 weeks, 83 screws (52.5%) had a follow-up of more than 6 months. During follow-up, 7.6% of screws loosened. Operative revision was performed in 13%. 75 fractures (90.3%) with a follow-up of ≥ 6 months showed radiographic evidence of healing. There was no difference in the healing rate of high-energy and fragility fractures. Nonunion rate was not dependent on the quality of primary reduction, secondary displacement, or screw loosening. Infection (p 0.001) and surgery ≥ 6 months aft