Search Results (135)

Background/Objective: Oblique lumbar interbody fusion (OLIF) achieves indirect decompression through restoration of disc height. Because maintenance of the restored disc space is essential for sustained neural decompression, solid fusion without cage subsidence is a key determinant of successful surgical outcomes. This study aimed to evaluate preoperative and intraoperative predictors of cage subsidence and radiographic fusion after OLIF. Methods: Seventy patients (119 levels) who underwent OLIF using a polyether–ether–ketone cage and posterior screw fixation between 2015 and 2023 were retrospectively reviewed. Preoperative bone quality was assessed using the computed tomography-based Hounsfield unit (HU) and magnetic resonance imaging-based vertebral bone quality (VBQ) score on T1-weighted images. Radiographic parameters of anterior and posterior disc height (ADH, PDH), segmental and lumbar lordotic angle (SLA, LLA), foraminal height (FH), and cage position were measured preoperatively at one-year follow-up. Results: Cage subsidence occurred in 21.0% of spinal levels (25/119 levels). Multivariate analysis identified these measures as independent predictors: HU (OR 1.017; p = 0.012), VBQ score (OR 2.716; p = 0.016), and PDH distraction (OR 1.418; p = 0.019). ROC analysis identified cutoff values of HU < 145.86 (AUC = 0.654), VBQ score > 3.30 (AUC = 0.723), and PDH distraction > 4.79 mm (AUC = 0.672). None of the evaluated factors were significantly associated with one-year radiographic fusion. Conclusions: Lower HU, higher VBQ score, and excessive PDH distraction are independent risk factors for cage subsidence after OLIF, although these factors do not appear to affect short-term fusion outcomes. Full article

Bone cement is used in spinal procedures and can be used alone or in combination with an implant to stabilize spine and relieve pain. Despite benefits, complications remain a concern. This study investigates how the internal geometry of a spinal implant device affects injection pressure and cement distribution. Two design groups (G1 and G2), differing in lateral channel angle, were analyzed across three functional variants using CFD (Computational Fluid Dynamics) simulations. CFD modeling employed a two-phase (air–cement) flow. Experimental tests confirmed simulation tests and revealed that angled channels (G2) promoted more uniform cement flow. CFD analysis showed reduced pressure on the syringe plunger, especially when the central channel was blocked. Threaded configurations increased the needed pressure but had minimal impact on flow distribution. G2 required a higher force exerted on the syringe plunger than G1. The study concludes that channel geometry significantly affects the required cement delivery pressure and implant fixation, which translates into the implant–bone interface. While certain configurations improve flow uniformity, elevated injection pressure may pose risks. These findings support optimizing implant design and cement delivery techniques, contributing to safer and more effective implant-based spinal surgeries with bone cement augmentation. Full article

Background/Objectives: Long-term bisphosphonate (BP) therapy is an effective treatment for osteoporosis but has been associated with rare complications such as atypical femoral fractures (AFFs). Emerging reports suggest that similar insufficiency fractures may also occur in other skeletal sites, including the lumbar pedicles. This study reports two rare cases of isolated bilateral lumbar pedicle stress fractures in patients on prolonged BP therapy. Along with a structured literature review, the objective was to evaluate whether diagnostic criteria derived from those used for AFFs may apply to these atypical vertebral fractures. Methods: Two patients with osteoporosis and on long-term BP therapy diagnosed with isolated lumbar pedicle stress fractures were retrospectively analyzed. A structured literature review identified similar reported cases. All cases were evaluated using the 2010 American Society for Bone and Mineral Research AFF criteria to assess applicability to isolated pedicle stress fractures. Results: Both patients demonstrated bilateral lumbar pedicle fractures without vertebral body involvement. One was treated conservatively; the other underwent robotic-assisted percutaneous pedicle screw fixation with documented fracture healing at six months. The literature review identified eight similar cases of isolated pedicle fractures in patients on prolonged BP therapy. Clinical course and imaging findings demonstrated stress-type features analogous to AFFs. The proposed AFF-based diagnostic criteria for pedicular insufficiency fractures were found to be applicable to all ten patients. Conclusions: Isolated bilateral pedicle stress fractures may represent a spinal analog of AFFs. Based on shared clinical and imaging features, we propose preliminary diagnostic criteria for atypical pedicular insufficiency fractures. Increased awareness and standardized criteria may aid in early diagnosis and reporting, encouraging further studies on this rare spinal entity. Full article

Background/Objectives: Cement-augmented fenestrated pedicle screws (CAFPSs) are widely used to enhance fixation strength in osteoporotic vertebrae; however, cement leakage remains a major concern because it can lead to severe complications. This study aimed to clarify the frequency, patterns, and risk factors of cement leakage using postoperative computed tomography (CT). Methods: A total of 302 screws placed in 79 osteoporotic patients who underwent spinal fixation with CAFPSs between March 2022 and December 2024 were retrospectively analyzed. Cement leakage was evaluated using postoperative CT, and risk factors were examined by logistic regression and receiver operating characteristic (ROC) curve analysis. Results: Cement leakage was observed in 46 patients (58.2%) and 71 screws (23.5%), but no severe complications such as symptomatic pulmonary embolism occurred. Multivariate analysis identified right-sided screw insertion (OR = 2.498, 95% CI: 1.270–4.913, p = 0.008) and shorter lateral cortical wall distance (OR = 0.547, 95% CI: 0.469–0.638, p < 0.001) as independent risk factors. ROC curve analysis demonstrated high predictive accuracy for lateral cortical wall distance (area under the curve = 0.842), with a cutoff value of 9.21 mm (sensitivity = 0.845; specificity = 0.719). Cement leakage occurred significantly more frequently in the thoracic spine than in the lumbar spine (34.2% vs. 17.0%, p < 0.001). Conclusions: Right-sided screw insertion and shorter lateral cortical wall distance were identified as major risk factors for cement leakage with CAFPSs. Quantitative CT-based assessment may contribute to risk stratification and optimization of screw placement planning to improve surgical safety. Full article

Background/Objectives: Spinal fusion with static fixation—surgically joining two or more vertebrae to eliminate motion—is commonly employed to treat degenerative spinal disease. However, the rigidity imposed by static constructs and the increased load on the adjacent segments frequently result in complications such as disc or facet degeneration, spinal stenosis (SS), and segmental instability. This study investigates the effectiveness of pedicle-based dynamic stabilization using the Dynesys system, particularly in a dynamic-transitional optima (DTO) hybrid configuration, in mitigating adjacent segment disease (ASD) and improving clinical outcomes. In this work, we analyzed the mechanical performance and intermediate-term clinical effects of the DTO hybrid lumbar device, focusing on how the load-sharing properties of the Dynesys cord–spacer stabilizers may contribute to junctional complications in individuals with diverse grades of intervertebral disc degeneration. Study Design/Setting: We designed a combined biomechanical finite element (FE) and experimental analysis to predict the clinical outcomes. Patient Sample: Among 115 patients with lumbar SS enrolled for analysis, 31 patients (mean age: 68.5 ± 7.5 years), with or without grade I spondylolisthesis (18/13), underwent a two-level DTO hybrid procedure—L4–L5 static fixation and L3–L4 dynamic stabilization—with minimal decompression to preserve the posterior tension band. Post-surgical follow-ups were conducted for over 48 months (range: 49–82). Outcome Measures: Radiological assessments were performed by two neurosurgeons, one orthopedic surgeon, and one neuroradiologist. The posterior disc height, listhesis distance, and dynamic angular changes were measured pre- and postoperatively to evaluate ASD progression. Methods: Dynamic instrumentation was assigned to the L3–L4 motion segment with lesser disc deterioration, in contrast to the L4–L5 segment, where static fixation was applied due to its greater degree of degeneration. FE analysis was performed under displacement-controlled conditions. Intersegmental motion analysis was conducted under load-controlled conditions in a synthetic model. Results: The DTO hybrid devices reduced stress and motion at the transition segment. However, compensatory biomechanical effects were more pronounced at the adjacent cephalad than the caudal segments. In the biomechanical trade-off zone—where balance between motion preservation and stabilization is critical—the flexible Dynesys cord significantly mitigated stiffness-related issues during flexion. At the L3–L4 transition level, the cord–spacer configuration enhanced dynamic function, increasing motion by 2.7% (rotation) and 12.7% (flexion), reducing disc stress by 4.1% (flexion) and 12.9% (extension), and decreasing the facet contact forces by 4.9% (rotation) and 15.6% (extension). The optimal cord stiffness (50–200 N/mm) aligned with the demands of mild disc degeneration, whereas stiffer cords were more effective for segments with higher degeneration. The pedicle screw motion in dynamic Dynesys systems—primarily caused by axial translation rather than vertical displacement—contributed to screw–vertebra interface stress, influenced by the underlying disc or bone degeneration. Conclusions: Modulating the cord pretension in DTO instrumentation effectively lessened the interface stress occurring at the screw–vertebra junction and adjacent facet joints, contributing to a reduced incidence of pedicle screw loosening, ASD, and revision rates. The modified DTO system, incorporating minimal decompression and preserving the posterior complex at the dynamic level, may be biomechanically favourable and clinically effective for managing transitional degeneration over the mid-term. Full article

Posterior instrumentation is used to treat severe adolescent idiopathic scoliosis (AIS) with a Cobb angle greater than 40 degrees. Clinical studies indicate that AIS patients may develop adjacent segment degeneration (ASD) post-surgery. However, there is limited research on the biomechanical effects on adjacent segments after surgery, and straightforward methods for creating finite element (FE) models that reflect vertebral deformation are lacking. Therefore, this study aims to use biplanar X-ray images to establish a case-specific, parameterized FE model reflecting coronal plane vertebral deformation and employ FE analysis to compare pre- and postoperative changes in the range of motion (ROM), endplate stress, and intervertebral disk stress of adjacent segments. We developed an FE model from biplanar X-ray images of a patient with AIS, using ANSYS software to establish pre- and postoperative models. The shape of the preoperative model was validated using computed tomography (CT) reconstruction. A flexion moment was applied to C7 of the spine model to achieve the same forward bending angle in the pre- and postoperative models. This study successfully developed a case-specific parameterized FE model based on X-ray images. The differences between Cobb angle and thoracolumbar kyphosis angle measurements in X-ray images and CT reconstructions were 6.5 and 5.4 mm. This FE model was used to analyze biomechanical effects on motion segments adjacent to the fixation site, revealing a decrease in maximum endplate and disk stress in the cranial segment and an increase in stress in the caudal segment. Full article

Background and Objectives: Unilateral spinal stabilization has emerged as a less invasive alternative to bilateral fixation in the management of lateralized spinal pathologies. While both rigid and dynamic systems are utilized, comparative data regarding their clinical efficacy, radiological outcomes, and complication profiles—particularly in multilevel applications—remain limited. Materials and Methods: A retrospective, two-center analysis was conducted on 113 patients who underwent unilateral posterior spinal stabilization between 2019 and 2023. Patients were divided into unilateral rigid stabilization (URS, n = 41) and unilateral dynamic stabilization (UDS, n = 72) groups. Pathologies of the patients include disc herniations, foraminal and spinal stenosis, tumoral lesions and spondylolisthesis. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) over a 24-month follow-up. Radiological parameters included fusion status, superior adjacent disc height, and foraminal height index. Complication rates, including adjacent segment degeneration (ASD), pseudoarthrosis, and screw loosening, were analyzed according to type-of-stabilization and construct length (two, three, or four levels). Results: Both URS and UDS groups demonstrated significant VAS improvement at final follow-up, with no significant differences between groups (p < 0.001). Fusion rates were significantly higher in the URS group (85.37% vs. 27.78%, p < 0.001), while pseudoarthrosis (39.02% vs. 16.62%, p = 0.081) were more frequent in URS. No cases of rod fracture or infection were observed. Complication rates, particularly ASD, increased with longer constructs (6.56%, 21.21%, vs. 31.58% p = 0.01), independent of stabilization type. Conclusions: Unilateral stabilization—whether rigid or dynamic—offers effective symptom relief with reduced surgical morbidity. However, dynamic systems may provide biomechanical advantages by preserving motion and minimizing adjacent segment stress. While rigid constructs yield higher fusion rates, they are associated with increased complications. These findings support the use of dynamic stabilization, particularly in multilevel constructs, and highlight the need for patient-specific surgical strategies to optimize outcomes and mitigate long-term complications. Full article

Background: Sacral and pelvic insufficiency fractures (SIFs and PIFs) are increasingly recognized yet frequently underdiagnosed complications after adult spinal deformity (ASD) surgery, particularly in patients undergoing long-segment spinal fusion to the sacrum or pelvis. Methods: We present a representative case of sacral and pelvic insufficiency fractures following extensive spinal fusion, highlighting diagnostic and therapeutic challenges. In addition, a systematic review of the literature was performed according to PRISMA guidelines through PubMed, MEDLINE, and Scopus databases, including studies up to December 2024. Data regarding demographics, risk factors, diagnostic modalities, management strategies, and outcomes were extracted and narratively synthesized. Results: A total of 21 studies comprising 89 patients were included. The majority were elderly postmenopausal women with osteoporosis and additional risk factors such as chronic corticosteroid therapy or high body mass index. Diagnosis was frequently delayed due to low sensitivity of plain radiographs, whereas computed tomography was the most reliable modality. Management was surgical in 49 patients (55%)—most commonly extension of fixation to the pelvis or use of S2-alar-iliac screws—with favorable fracture healing reported in most cases. Conservative treatment, employed in 40 patients (45%), included bracing, restricted activity, and bone health optimization, also leading to healing in the majority of cases. Conclusions: Sacral and pelvic insufficiency fractures represent an underrecognized but clinically significant complication after ASD surgery. Early recognition through cross-sectional imaging (CT/MRI) is crucial, and both surgical and conservative approaches can be effective if tailored to patient and fracture characteristics. Full article

Background and Objectives: Diffuse idiopathic skeletal hyperostosis (DISH)-related spinal fractures with marked anterior distraction are highly unstable and pose substantial surgical challenges. The transdiscal screw for diffuse idiopathic skeletal hyperostosis (TSD) technique has been proposed to enhance fixation strength by penetrating adjacent vertebral endplates; however, its clinical utility in large-displacement cases remained unclear. Materials and Methods: In this retrospective study, we reviewed 21 patients with thoracolumbar DISH-related fractures and an anterior fracture gap ≥ 15 mm, who underwent posterior fixation between 2010 and 2024. 11 patients underwent TSD fixation (TSD group), and 10 underwent conventional fixation without bilateral TSD (control group). Results: The mean number of fused segments did not differ significantly between the groups (5.0 ± 1.4 vs. 5.0 ± 1.3, p = 0.43). Operative time was comparable (164 ± 57 vs. 168 ± 60 min, p = 0.90). Blood loss tended to be lower in the TSD group (306 ± 334 vs. 528 ± 658 mL, p = 0.33). For fracture-gap reduction, the TSD group improved from 17.4 ± 2.3 mm preoperatively to 13.8 ± 4.4 mm postoperatively and 2.0 ± 3.6 mm at final follow-up, while the control group showed less reduction (16.8 ± 2.2, 15.4 ± 1.4, and 7.0 ± 9.1 mm, respectively). Screw loosening occurred in three TSD patients and six controls (p = 0.13). All patients in the TSD group achieved bone union without reoperation, whereas four controls experienced implant backout, three required reoperation, and two failed to achieve bone union (p = 0.035). Conclusions: Posterior fixation using TSD provided reliable stability, maintained reduction, and reduced the risk of implant failure compared with conventional fixation in highly unstable DISH-related fractures with anterior distraction. Although larger prospective studies are needed, TSD may represent a valuable surgical option for this challenging patient population. Full article

Spinal tumours are an uncommon but significant cause of pain, fractures, instability, and cord compression, leading to poor quality of life and mortality. Separation surgery is a rapidly advancing technique that has seen increased utilisation in the field of spinal oncology surgery. Separation surgery can be described as a resection technique that decompresses the spinal cord whilst creating an ablative target for high-dose stereotactic radiotherapy to achieve durable local control while minimising the risk of radiation myelopathy. This has facilitated the delivery of stereotactic radiotherapy, as well as created potential for use in managing primary bone tumours of the spine. From a radiology standpoint, optimal outcomes depend on meticulous preoperative characterisation of tumour volume and stability (e.g., ESCC grade and SINS), clear communication of anatomic constraints relevant to approach and fixation, and systematic postoperative surveillance to distinguish expected postoperative appearances from early recurrence or complications. We present our radiological experience and report recommendations while evaluating spinal oncology separation surgery. Full article

Background: Fractures of the first and second cervical vertebrae are common in both young and elderly patients. Surgical management of C1–C2 fractures in elderly patients is controversial. The aim of this study is to report the rate of fusion in elderly patients who underwent surgery for C1 or C2 fractures. Methods: A retrospective review of all patients over the age of 65 years old who underwent surgical treatment for C1 or C2 fracture was reported. Visual analog scale (VAS) and neck disability index (NDI) were used to assess patients’ clinical outcome at 1 year follow-up. Cervical spine computer tomography (CT) scans were performed in all cases before surgery and at 1 year follow-up to evaluate the long-term postoperative rate of fusion, according to Lenke fusion grade. Results: From 2019 to 2023, 105 patients with cervical craniocervical junction (CCJ) fracture underwent surgical treatment in our Pisana University Hospital. Among all these, 74 patients (70.5%) were over 65 years old. The mean age of the study population was 76.9 years old (12.2% aged 65–70, 51.4% aged 70–79, and 36.5% over 80). According to the AO Spine Upper Cervical Injury Classification System, 6 (8.1%) patients presented a type II fracture and 68 (91.9%) patients presented a type III fracture. At admission, neurological examination resulted in American Spinal Injury Association (ASIA) E in 97.3% of cases. Over 60% of all patients underwent C1–C2 posterior fixation. Postoperative complications occurred in 12.25% of patients. According to the criteria described by Lenke, a good rate of fusion (A-B grade) was obtained in 71.6% of patients. Conclusions: In elderly patients with CCJ fractures, precision medicine can help identify those at higher risk for complications and guide personalized treatment strategies. Surgical treatment of CCJ fractures in elderly patients, although not always associated with bone fusion, can be performed with an acceptable incidence of mortality and morbidity, allowing rapid mobilization and return to pre-trauma levels of independence. Full article

Objectives: This study aimed to determine the incidence of postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE) following orthopedic surgeries and to identify independent clinical, laboratory, and procedural factors associated with thromboembolic risk. Materials and Methods: A retrospective cohort analysis was conducted on 300 patients who underwent elective or emergency orthopedic surgeries (hip/knee arthroplasty, fracture fixation, and spinal procedures) between January 2020 and December 2024 at two tertiary centers. Demographic, clinical, and biochemical data were collected. Patients were stratified into two groups: those who developed DVT/PE and those who did not. Univariate analyses were performed to identify significant factors, and a multivariate logistic regression model with stepwise variable selection was applied in accordance with the events-per-variable (EPV) criterion. Receiver operating characteristic (ROC) curve analyses were conducted to evaluate the discriminative performance of significant predictors. Results: Among 300 patients who underwent orthopedic surgery, postoperative deep vein thrombosis (DVT) and/or pulmonary embolism (PE) occurred in 50 cases (16.7%). Patients who developed thromboembolic events were older (72.5 ± 8.7 vs. 65.2 ± 10.1 years, p < 0.001), had higher body mass index (32.1 ± 5.3 vs. 28.3 ± 4.5 kg/m², p < 0.001), and showed a greater prevalence of diabetes mellitus (40% vs. 20%, p < 0.01) and chronic kidney disease (24% vs. 10%, p < 0.001) compared to those without DVT/PE. Laboratory analyses revealed significantly elevated neutrophil count, D-dimer, C-reactive protein (CRP), glucose, and troponin levels in the DVT/PE group. In the stepwise multivariate logistic regression model, age (OR = 1.44, p = 0.003), diabetes mellitus (OR = 2.88, p = 0.046), chronic kidney disease (OR = 2.33, p = 0.014), D-dimer (OR = 2.15, p = 0.019), and immobilization duration (OR = 2.21, p = 0.028) emerged as independent predictors of thromboembolic events. ROC analysis revealed that D-dimer > 0.9 mg/L had the highest discriminative performance (AUC = 0.89, sensitivity 88%, specificity 84%, p = 0.003), followed by troponin > 0.5 U/L (AUC = 0.86, p = 0.005), immobilization > 3 days (AUC = 0.82, p = 0.012), and age > 65 years (AUC = 0.74, p = 0.021). Conclusions: DVT and PE remain significant postoperative complications with a multifactorial etiology in orthopedic surgeries. Advanced age, comorbidities (such as diabetes mellitus and chronic kidney disease), and elevated inflammatory and metabolic markers (including neutrophil count, glucose, CRP, and D-dimer), together with procedural factors like prolonged immobilization, were identified as independent risk factors. Early recognition of these high-risk features and implementation of individualized prophylaxis strategies may improve postoperative outcomes and reduce thromboembolic risk. Full article

Purpose: Thoracolumbar burst fractures represent a significant proportion of spinal injuries, with management strategies remaining a subject of debate. While four-screw (4S) short-segment posterior fixation is commonly used, recent biomechanical studies suggest that adding pedicle screws at the fractured level (six-screw, 6S, construct) may improve stability and clinical outcomes. However, the clinical relevance of these findings remains uncertain. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Three databases (Scopus, PubMed/MEDLINE, Cochrane Library) were searched for studies comparing 4S and 6S constructs in thoracolumbar fractures. Inclusion criteria encompassed comparative clinical studies reporting perioperative, functional, and radiological outcomes. Data were extracted and analyzed using Review Manager 5.4.1, applying fixed- or random-effects models based on heterogeneity. Results: Twenty-two studies involving 1595 patients were included. The 6S group showed significantly improved postoperative pain scores (VAS), better short- and long-term sagittal alignment, and a lower implant failure rate. However, this technique was associated with longer operative times, increased intraoperative blood loss, and extended hospital stays. No significant differences in long-term functional disability (ODI) or infection rates were found. Conclusions: The addition of intermediate screws improves radiological outcomes and reduces implant failure but increases surgical burden. Further high-quality studies focusing on patient-reported outcomes and specific fracture subtypes are needed to refine clinical indications. Full article

Background/Objectives: Given the different biomechanical properties and surgical techniques between the L5-S1 and ≥L4-5 levels, it is necessary to explore RF risk factors at ≥L4-5 levels separately from the lumbosacral junction. This study aims to investigate the risk factors for rod fracture (RF) occurring at ≥L4-5 levels following adult spinal deformity (ASD) surgery. RF occurrence was assessed at the segment level. Methods: Patients who underwent ≥ 5-level fusion, including the sacrum or pelvis, with a minimum follow-up of 2 years were included in this study. Presumed risk factors in terms of patient, surgical, and radiographic variables were compared between the non-RF and RF groups at the segment level. Multivariate logistic regression analysis was performed to identify independent risk factors for RF at ≥L4-5 levels. Results: A total of 318 patients (mean age, 69.3 years; 88.4% female) were included, and 1082 segments were evaluated. During the mean follow-up duration of 47.4 months, RF developed in 45 (14.2%) patients for 51 (4.7%) segments. In multivariate logistic regression analysis, several risk factors were identified, as follows: the use of perioperative teriparatide (odds ratio [OR] = 0.26, p = 0.012), operated levels (L2-3 and L3-4 vs. L4-5 level [OR = 0.45, p = 0.022; OR = 0.16, p < 0.001, respectively]), fusion methods (posterior fusion and anterior column realignment vs. posterior lumbar interbody fusion [OR = 8.04, p < 0.001; OR = 5.37, p = 0.002, respectively]), pedicle subtraction osteotomy (PSO) (OR = 3.14, p = 0.020), and number of rods (four-rod configuration vs. dual-rod fixation [OR = 0.34, p = 0.044]). Conclusions: In this study, the factors related to RF at ≥L4-5 levels included the perioperative use of teriparatide, operated levels, fusion methods, performance of PSO, and rod configuration. Considering that surgical procedures vary by each segment, our findings may help establish segment-specific preventive strategies to reduce RF at ≥L4-5 levels. Full article

Background: Pelvic fractures are complex injuries often associated with significant morbidity and mortality, requiring multidisciplinary management. This case series highlights the presentation, management strategies, and outcomes of patients with pelvic fractures treated at our institution. Methods: The medical records of 13 patients diagnosed with pelvic fractures from 1 January 2020 through 31 December 2023 were retrospectively reviewed. Demographic data, mechanism of injury, fracture pattern, associated injuries, treatment modalities, and outcomes were analyzed. Results: A total of 13 patients were included in the study, with ages ranging from 18–95 years. Six of the patients were male and seven were female. The most common mechanisms of injury were falls and pedestrians struck by vehicles. Associated injuries included traumatic brain injury (TBI), fractures including extremities, ribs, and vertebrae, visceral injury, and spinal cord injury. Treatment strategies ranged from conservative, non-surgical management to operative intervention, including interventional radiology embolization, external traction, open reduction and internal fixation (ORIF), and percutaneous screw stabilization. Additional interventions included chest tube placement, exploratory laparotomy, and craniectomy. Two patients died while in the hospital, one was discharged to a shelter, and the remaining 10 were discharged to various inpatient rehab facilities. Conclusions: Pelvic fractures pose significant clinical challenges due to their complexity and associated injuries. This case series underscores the importance of multidisciplinary intervention and treatment strategies in optimizing outcomes. Further studies should focus on the effectiveness of interventions, utilization of new technology, and multidisciplinary team planning. Full article