Background: The management of lateral compression type 1 (LC-1) pelvic fractures remains controversial. Posterior fixation alone has traditionally been practiced without clearly defined indications for supplementary anterior stabilization. Direct comparative evidence between posterior-only and combined anterior–posterior fixation remains scarce. This study evaluated whether institutional criteria reliably identify patients who benefit from additional percutaneous anterior fixation. Methods: A retrospective cohort study was conducted at a level I trauma center and included adults with LC-1 fractures treated exclusively by percutaneous fixation. Combined anterior–posterior fixation was performed when predominant anterior pain and radiographic compromise indicated instability. Primary outcomes were pain trajectory (Numeric Rating Scale), inpatient opioid use, physiotherapy clearance, and ward mobility. Results: Thirty-seven patients were analyzed (combined = 14; posterior-only = 23). Preoperative pain was higher in the combined group (median 7 vs. 6; median difference 1 [95% CI 0 to 2]; p = 0.0036). Postoperatively, pain scores were lower in the combined group at 1–6 weeks (median difference −1 [95% CI −2 to 0]; p < 0.05). Opioid consumption was reduced (193 mg vs. 312 mg; median difference −200 mg [95% CI −280 to −120]; p < 0.001), and physiotherapy clearance occurred earlier (4 vs. 7 days; median difference −3 [95% CI −5 to −1]; p = 0.020). Conclusion: Our current indications to perform combined fixation were associated with favorable early outcomes in pain control and physiotherapy clearance among patients with LC-1 fractures showing anterior compromise. These results support a selective combined approach, though interpretation must remain cautious given the small retrospective cohort. Further prospective studies are warranted to validate these findings and refine patient selection.

Purpose: To compare early postoperative results for the management of acetabular fractures using open reduction and internal fixation versus acute total hip replacement with a cementless modular cup in patients older than 55 years. Methods: This was a retrospective cohort study conducted at a Level I trauma center between April 2019 and March 2024, including 36 consecutive patients aged ≥ 55 years with displaced acetabular fractures treated by a single senior pelvic surgeon using open reduction and internal fixation ( n = 20), stand-alone total hip replacement ( n = 9), or a planned two-stage combined hip procedure ( n = 7). The primary outcome included Harris Hip Score at 6 months, Secondary outcomes included postoperative complications, unplanned reoperation, and radiographic implant assessment. Results: At six months, both replacement groups showed significantly better functional outcomes (mean Harris hip scores of 83 and 82) compared to the fixation-only group (mean score of 57; p < 0.001). All reoperations (4/20) occurred in the fixation group, while no reoperation was required in the replacement groups. Radiographic evaluation confirmed stable implant fixation in all arthroplasty cases, without signs of loosening or dislocation. Conclusion: According to our treatment algorithm, acute total hip replacement using a modular revision cup with an iliac peg, with or without plate osteosynthesis, offers the advantage of early full weight-bearing and promising functional outcomes in the management of complex acetabular fractures. These results support the integration of acute total hip replacement into structured decision-making protocols especially for elderly patients.

Background Automated pelvic CT segmentation has advanced to reliable coarse bone extraction. Yet the structured anatomical hierarchy required for morphometry, fixation planning, bone quality mapping, and arthroplasty workflows remains unachieved. This study developed and validated a fully automated anatomy-informed pipeline that converts standard pelvic CT into a comprehensive, surgeon-readable subsegmentation of the pelvis and proximal femur. Methods Pelvic CT datasets were retrospectively collected from anonymized archives of hospitals affiliated with the Directorate of Health Affairs, Sharqia, Egypt. After eligibility screening, 757 normal adult cases were processed using a custom one-click 3D Slicer pipeline integrating TotalSegmentator for coarse extraction, followed by deterministic anatomy-based subsegmentation into 81 segments. One hundred randomly selected cases were validated against expert-corrected reference segmentations using Dice similarity coefficient, volume difference, surface distance metrics, and bilateral symmetry analysis. Results Of 1,316 screened cases, 757 met eligibility criteria. Across 8,100 case-segment observations, the pipeline achieved a mean Dice of 0.9926 +/- 0.0465. Complete agreement was observed for the sacrum, ilium, acetabulum, anterior and posterior columns, sciatic buttress, and all landmarks. Relative decreases were confined to boundary-dependent regions. Bilateral symmetry analysis confirmed a median surface agreement of 99.85% within 5 mm. Conclusion The pipeline demonstrated high accuracy and reproducibility across a large normal adult dataset, establishing a structured anatomical foundation for quantitative pelvic analysis and surgical planning workflows. Clinical feasibility across abnormal anatomy and decision-level applications awaits dedicated validation.

Background: The pelvis is among the most demanding regions in musculoskeletal imaging, and CT is its reference standard. Available automated tools, however, largely produce whole-bone or single-task masks, leaving the finer surgical subregions to slow, operator-dependent manual work. We developed a rule-based pipeline that converts pelvic and proximal femoral masks into a structured map of surgically meaningful subregions and landmarks, quantifying the manual correction burden required to achieve anatomically acceptable outputs. Methods: Anonymized pelvic CT scans were collected retrospectively; after predefined quality criteria, 757 of 1,316 screened normal adult cases were processed by a one-click pipeline in 3D Slicer. Parent structures from TotalSegmentator were divided by fixed anatomical rules into columns, acetabular regions, and proximal femoral regions. In 100 randomly selected cases, every segment was expert-reviewed and corrected where needed; correction frequency was the primary endpoint, with accuracy computed for corrected segments only. Pipeline performance was also assessed in a 60-case pathological-anatomy cohort for affected segments against manually segmented ground truth. Results: Of 8,100 segment observations, 93.8% were accepted without correction, and 51 of 81 segments required no correction in any case. Correction clustered in a few boundary regions, mainly the ischium and femoral neck (median 4.5 segments per case). Computed only on the corrected segments, the median Dice was 0.94, indicating that errors were modest where they occurred. A secondary symmetry analysis showed median surface agreement of 90% within 2 mm and 99.9% within 5 mm. In the pathological-anatomy cohort, pooled median Dice was 0.970 across affected components. Pooled landmark error was 5.37 mm median, with 91.9% of manual clicks inside the automated landmark. Conclusions: Validated in normal adult anatomy, this rule-based pipeline converts pelvic and proximal femoral CT into a structured hierarchy of clinically relevant subregions, needing only limited, predictable correction. It substantially reduces manual workload while preserving the anatomical detail needed for morphometry and dataset generation. Performance held up in an initial pathological-anatomy sample. Extension to fracture, deformity, or clinical decision-making requires dedicated validation in abnormal anatomy.