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Table 1 Summary of results from included studies

From: Operative management of fragility fractures of the pelvis – a systematic review

Author, year and Study type Patients Classification and numbers Indication for surgery Fixation Method Screw Augment X-ray/CT Post op weight bearing Outcome measures Results
     Posterior Anterior      
Osterhoff etal. 2019 Retrospective case control [24] 230 “Low energy fractures of the pelvis” Inability to mobilise 3–5 days post injury 2 SIJ screws - Unilateral = 33 bilateral = 24 Spinopelvic = 2 plate = 2. Plate = 8 Ramus screw = 5 Infix = 4 X-ray WBAT 1 and 2 year mortality. Majeed score Overall 1 year mortality 21%. 23% early operative vs 17% non-operative p = 0.29. Majeed Score 66.1 operative vs 65.7 non-op (p = 0.91) @ 61 months average f/u. LoS 12 days operative vs 8 days non-op p = < 0.001
Balling etal. 2019 Randomised trial [25] 52 Rommens Type 2 = 52 Failed conservative management for 14 days Minimum 2 transacral screws. 26 with sacroplasty, 26 without. none Additional sacroplasty in 26 CT WBAT VAS, ODI, Length of stay Mean pre-op VAS SIJ 8.8 vs 9.0 SIJ + SP. Discharge VAS 3.5 and 3.6 respectively. P = < 0.05. No difference between groups. LoS 9.3 days SIJ vs 9.6 days SIJ + SP. Pre-op mean ODI SIJ 86.1 vs 86.2 SIJ + SP Decreased to 32.7 and 28.5 respectively at discharge.
Oikonomidis etal. 2019 Retrospective case series [26] 32 Rommens Type 1 = 1 Type 2 = 22 Type 3 = 9 Inability to mobilise after 1 week Single SIJ screw = 31 Photodynamic bone stabilisation system = 32 X-ray WBAT VAS, length of stay, mortality 3% Mortality at 7.5 months. Mean discharge VAS 4.4, follow up VAS 3.0. Average LoS 16.5 days
Walker etal. 2018 Retrospective Cohort [27] 41 Young & Burgess LC1 = 26 “Sacral U” = 16 Inability to ambulate or severe pain on ambulation Single transacral screw = 15, Double transacral screw = 1 none X-ray WBAT VAS, LoS VAS on admission operative group 7.4 improved to 3.5 on discharge, non-op 5.7 to 5.1. p = < 0.001 LoS 3.6 operative vs 4.2 non operative P = 0.51
Pulley etal. 2018 Retrospective case series [28] 16 “Sacral U” = 16 Failure of conservative management or inability to weight bear 2 transacral screws = 13, 2 SIJ screws bilaterally = 1, 1 transacral screw + 1 SIJ screw bilaterally = 1, 1 SIJ screw bilaterally = 1 none X-ray WBAT VAS Average improvement in pre to post op VAS 3.7 p = < 0.05
Hoch etal. 2017 (1) Retrospective Case series [6] 128 OTA B2.1 = 115 B3.3 = 13 Operative, non-operative and failed non-operative groups Unable to mobilise after 3 days with adequate analgesia Single SIJ screw = 28, 2 SIJ screws = 6, Bilateral SIJ screws = 14, Triangular fixation = 2. Plate = 3 Additional sacroplasty in 13 CT in 7 cases WBAT VAS, SF12, LoS, Mortality, EQ. 5D 2 Year mortality 41% non-op vs 20% operative p = < 0.05. Mean LoS 18.1 operative vs 9.2 non-op P = < 0.001. Mean EQ. 5D at 2 years non-op 75.1, failed non-op 76.3, operative 74.6 - no significant difference. SF12 no difference between groups
Eckardt etal. 2017 Retrospective case series [29] 50 Rommens Type 2 = 15, Type 3 = 10, Type 4 = 25 persistent mobility limiting pain Single screw = 37, 2 screws = 11, Plate = 2. transacral screws = 23, SIJ screws = 27 Plate = 14 (combined with single screw = 11, double screw = 1) CT WBAT VAS, TUG, Mortality 1 year mortality 10%. TUG test at 2 years: 0–10s 5pts (16%), 10–20s 15pts (44%), 20–30s 7pts (22%), > 30s 6pts (19%). VAS at rest 0/10 20pts (61%), VAS 1–3 7pts (21%), VAS > 3 6pts (18%). Post TUG VAS 0/10 17pts (52%), VAS 1–3 6pts (18%) VAS > 3 10pts (30%)
Hoch etal. 2017 (2) Prospective case series [14] 34 Rommens Type 2 = 25 Type 4 = 8 Persistent immobilisation Single SIJ = 25, Double SIJ = 1, Single SIJ bilaterally = 8 Plate = 16, Ramus screw = 16 Plate and screw = 1 All screws augmented with PMMA X-ray WBAT VAS, SF12, LoS VAS on admission 6.7 admission vs 2.7 day prior to discharge (p = < 0.001) SF12 at 1 year no difference to age matched controls. LoS 14 days
Sanders etal. 2016 Retrospective case series [30] 11 Bilateral sacral = 7 Jumpers variant = 1 unilateral sacral = 2, S1 stress = 1 Failure of non-operative measures or pain limiting mobilisation 1 transacral screw = 10, 2 transacral screws = 1 none X-ray WBAT VAS, ODI, LoS, Mortality 1 year mortaility 10%. Mean VAS 9.1 pre-op vs 3.4 post-op and 2.4 final follow up P = < 0.01. Mean LoS 2.5 days, Mean ODI 71.6 pre-op to 17.6 post-op and 14.6 final follow up p = < 0.01
Collinge etal. 2016 Retrospective case series [8] 24 OTA B2.2 = 15, B3.3 = 8, C3.2 = 1 Acute fractures thought to be unstable or with marked pain limiting mobility Single SIJ screw = 15, Single transacral screw = 9 none All screws augmented with CaPO4 X-ray WBAT VAS Mean VAS 7.9 pre-op vs 3.4 at discharge p = < 0.001. VAS 3.2 at 6 weeks, 2.0 at final follow up
Hopf etal. 2015 Retrospective case series [19] 30 Anterior and posterior = 18, Unilateral posterior = 1, Bilateral posterior = 11 Persistent pain or unacceptable mobility reduction after 6 days conservative management Single SIJ = 6, Double SIJ = 12, Triple SIJ = 1, Bilateral SIJ = 2, Bilateral double SIJ = 6, Bilateral triple SIJ = 1, Bilateral SIJ - 2 screws one side, 1 screw other = 2, none X-ray WBAT VAS Mean VAS 6.8 on admission, 6.0 after bed rest vs 2 days post op VAS 3.6 p = < 0.001, 1.8 on discharge p = < 0.001
Arduini etal. 2015 Retrospective case series [31] 14 Rommens Type 2 = 3, Type 3 = 9, Type 4 = 2 6 months failed conservative treatment Single SIJ = 8, Plate and screw = 3, Spinopelvic fixation = 2 Screw = 2, plate = 3, ‘screw or plate in Rommens Type 3’ = 9 X-ray Bed rest for 4–6 weeks LoS LoS 6 days post-op
Wahnert etal. 2013 Retrospective case series [32] 12 “insufficiency fractures” = 12 5–7 days conservative treatment without improvement Single SIJ = 12 Infix = 3 All screws augmented with PMMA CT WBAT VAS Mean VAS 8.2 pre-op vs 2.6 post op (no statistical analysis performed)
Gansslen etal. 2013 Retrospective case series [7] 25 OTA B2.1 = 24, B3.3 = 1 not described none Supra-acetabular external fixator = 25 X-ray Partial on side of injury VAS, LoS Mean VAS pre-op 7.7, Post-op VAS 2.3 (p = < 0.001), Frame removal (mean 4 weeks) VAS 0.6 p = < 0.0003. Average discharge 7 days post op
Mehling etal. 2012 Retrospective case series [18] 11 “insufficiency fractures” fatigue fracture of sacrum or sacroiliac instability Transacral bar = 11 ORIF = 3 X-ray WBAT German Multicentre Pelvis Study Group Score German Multicentre Pelvis Study Group outcome score at 14 months - 7 point scale summarising radiological, clinical and social reintegration. 2 Excellent, 5 Good, 4 Fair
Lau etal. 2010 Retrospective case series [33] 37 Young & Burgess isolated pubic rami = 15, LC1 = 13, LC2 = 9 not described Plate = 7 Screw = 1 X-ray WBAT Mortality 1 year mortality: 27% Rami fractures, 23% LC1, 13% LC2 (Operative intervention in 7/9 LC2 only)
Vanderschot etal. 2009 Retrospective case series [34] 19 Unilateral sacral = 1, Bilateral sacral = 18 not described Transacral bar = 19 none CT WBAT VAS Mean VAS pre-op 6.8 to 2.3 at 9 months (p = < 0.001). LoS 3.6 op vs 4.2 non-op P = 0.51
  1. OTA Orthopaedic Trauma Association, LC1 Lateral Compression Type 1, LC2 Lateral Compression Type 2, SIJ Sacroiliac Joint, Infix Internal fixator, PMMA Polymethylmethacrylate, CT Computed Tomography, VAS Visual anologue scale, ODI Oswestry Disability Index, TUG Timed up and go test, LoS Length of Stay, WBAT Weight bear as tolerated, SP Sacroplasty