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 et∼al. 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 et∼al. 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 et∼al. 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 et∼al. 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 et∼al. 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 et∼al. 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 et∼al. 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 et∼al. 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 et∼al. 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 et∼al. 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 et∼al. 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 et∼al. 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 et∼al. 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 et∼al. 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 et∼al. 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 et∼al. 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 et∼al. 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 |