What's old is best again Is anterior plating best for fixation of type-C pelvic fractures? A systematic review and meta-analysis

Joshua Booth; Diana M Perriman; Jason Szczepanski; Dianne Walton-Sonda; Paul N Smith

doi:10.1016/j.injury.2021.09.004

What's old is best again Is anterior plating best for fixation of type-C pelvic fractures? A systematic review and meta-analysis

Injury. 2022 Feb;53(2):301-312. doi: 10.1016/j.injury.2021.09.004. Epub 2021 Sep 9.

Authors

Joshua Booth¹, Diana M Perriman², Jason Szczepanski³, Dianne Walton-Sonda⁴, Paul N Smith⁵

Affiliations

¹ The Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia; The Australian National University, Canberra, Australian Capital Territory, Australia. Electronic address: Joshua.booth@anu.edu.au.
² The Australian National University, Canberra, Australian Capital Territory, Australia; The Australian Capital Territory Health Library and Multimedia Service, The Canberra Hospital, Garran, Australian Capital Territory, Australia.
³ The Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia.
⁴ The Australian Capital Territory Health Library and Multimedia Service, The Canberra Hospital, Garran, Australian Capital Territory, Australia.
⁵ The Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia; The Australian National University, Canberra, Australian Capital Territory, Australia.

PMID: 34625237
DOI: 10.1016/j.injury.2021.09.004

Abstract

Background: Type-C pelvic fractures are a rare but potentially fatal injury that often leads to poor outcomes, despite surgical fixation. Many fixation methods are used but the optimal method remains contentious, with failure and complications common. This study compared outcomes for each fixation method.

Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search of studies which reported on outcomes after surgically treated type-C pelvic fractures was undertaken. Data retrieved included fixation method, length of follow up, surgical revision, and complications rates (hardware breakage, post-operative outcomes, screw mal-positioning, screw loosening, loss of reduction and infection). Study quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS). Pooled revision, outcome and complication rates were calculated using a quality-adjusted model in MetaXL 5.3.

Results: Fifty-two studies met the inclusion criteria representing 1567 patients and 7 fixation methods. The meta-analyses demonstrated high rates of 'less-than-good' outcomes for most fixation methods, with a higher rate for bilateral injuries (overall 23%; unilateral 21% v bilateral 41%). The mean pooled rate for surgical revision rate was 4%, hardware breakage 3%, screw mal-positioning 2%, screw loosening 3%, loss of reduction 5% and infection 4%. Each fixation method had different performance profiles; however, anterior plating outperformed all other fixation methods for patient outcomes, with a 'less-than-good' rate of just 7% vs the pooled mean of 23% and demonstrated at or below pooled mean rates for all complications except revision which was 5%.

Conclusions: Post-operative outcomes for surgically treated type-C pelvic fractures revealed a 'less-than-good' pooled outcome rate of 23% and a revision rate of 4%. Anterior plates outperformed most other systems particularly for patient reported outcomes. Pooled revision, patient-reported outcome and complication rates for type-C pelvic fractures have not previously been reported and these data provide a benchmark for practice and future research.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Bone Screws
Fracture Fixation, Internal
Fractures, Bone* / surgery
Humans
Pelvic Bones* / surgery
Reoperation