Weightbearing Progression After Percutaneous Fixation of Sacral Fracture with Pubic Rami Fractures

Immediate Postoperative Weightbearing Strategy

The fundamental goal of internal fixation for unstable pelvic ring injuries is to allow early functional rehabilitation and decrease long-term morbidity, chronic pain, and complications historically associated with prolonged immobilization, according to the World Journal of Emergency Surgery guidelines 1, 2

Touch-down weightbearing (TDWB) to partial weightbearing (PWB) at 20-30% body weight for patients with standard iliosacral screw fixation and stable anterior fracture patterns (transverse rami fractures), as recommended by the World Journal of Emergency Surgery 1, 2

Progress to PWB at 50% body weight for standard iliosacral screw fixation with stable anterior patterns, advancing by 25% every 2 weeks based on pain tolerance and radiographic evidence of healing, according to the World Journal of Emergency Surgery guidelines 1, 2

Serial radiographs at 2, 6, and 12 weeks postoperatively to assess for loss of reduction or hardware failure before advancing weightbearing status, as recommended by the World Journal of Emergency Surgery 1
Pain-guided progression: Patients should not advance weightbearing if experiencing significant pain at the fracture site, as this may indicate inadequate healing or construct failure, according to the World Journal of Emergency Surgery guidelines 2