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Internal versus external fixation of the anterior component in unstable fractures of the pelvic ring: pooled results from a systematic review

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Improving reduction of the pelvic ring improves long-term functional outcomes for patients. It has been demonstrated that posterior internal fixation is necessary to adequately control fractures to the posterior ring and there is evidence that supplementing this with fixation of the anterior ring improves stability. It is accepted that internal fixation provides greater stability than external fixation of the anterior ring but long-term differences in radiographic and functional outcomes have not yet been quantified.

Methods

A search of electronic databases, reference lists and review articles from 1989 to 2015 yielded 18 studies (n = 884) that met our inclusion criteria. We included studies that discussed pelvic ring injuries in adults, reported functional or radiological outcomes or complications by anterior ring intervention and exceeded 14 patients. We excluded biomechanical and cadaver studies.

Results

Internal fixation of the anterior pelvic ring had better functional and radiographic outcomes. Residual displacement of >10 mm was less common with internal fixation (ER 0.12, 95 % CI 0.06–0.24) than external fixation (ER 0.31, 95 % CI 0.11–0.62). Unsatisfactory outcomes also occurred at a lower rate (ER 0.09, 95 % CI 0.03–0.22) compared to external fixation (ER 0.32, 95 % CI 0.18–0.50). Losses of reduction (ER 0.02, 95 % CI 0.01–0.04 versus ER 0.07, 95 % CI 0.02–0.21), malunions (ER 0.03, 95 % CI 0.01–0.08 versus ER 0.07, 95 % CI 0.02–0.21) and delayed/non-unions (ER 0.02, 95 % CI 0.01–0.05 versus ER 0.04, 95 % CI 0.02–0.07).

Conclusions

Internal fixation of the anterior pelvic ring as supplementary fixation for unstable injuries to the pelvic ring appears to result in better radiographic and functional outcomes as well as fewer complications. However, data that separated outcomes and complications in relation to interventions of the anterior pelvic ring were limited. More studies looking specifically at outcomes in relation to the type of anterior ring intervention are needed.

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References

  1. Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury. 2004;35(7):671–7.

    Article  CAS  PubMed  Google Scholar 

  2. Guthrie HC, Owens RW, Bircher MD. Fractures of the pelvis. J Bone Jt Surg Br. 2010;92(11):1481–8.

    Article  CAS  Google Scholar 

  3. McLaren AC, Rorabeck CH, Halpenny J. Long-term pain and disability in relation to residual deformity after displaced pelvic ring fractures. Can J Surg. 1990;33(6):492–4.

    CAS  PubMed  Google Scholar 

  4. Durkin A, Sagi HC, Durham R, Flint L. Contemporary management of pelvic fractures. Am J Surg. 2006;192(2):211–23.

    Article  PubMed  Google Scholar 

  5. Flint L, Cryer HG. Pelvic fracture: the last 50 years. J Trauma. 2010;69(3):483–8.

    Article  PubMed  Google Scholar 

  6. Papakostidis C, Kanakaris NK, Kontakis G, Giannoudis PV. Pelvic ring disruptions: treatment modalities and analysis of outcomes. Int Orthop. 2009;33(2):329–38.

    Article  CAS  PubMed  Google Scholar 

  7. Matta JM. Indications for anterior fixation of pelvic fractures. Clin Orthop. 1996;329:88–96.

    Article  PubMed  Google Scholar 

  8. Oliver CW, Twaddle B, Agel J, Routt ML Jr. Outcome after pelvic ring fractures: evaluation using the medical outcomes short form SF-36. Injury. 1996;27(9):635–41.

    Article  CAS  PubMed  Google Scholar 

  9. Wiss DA. What’s new in orthopaedic trauma. J Bone Joint Surg Am. 2002;84-A(11):2111–9.

    PubMed  Google Scholar 

  10. Taguchi T, Kawai S, Kaneko K, Yugue D. Surgical treatment of old pelvic fractures. Int Orthop. 2000;24(1):28–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12 Epub 2009/07/28.

    Article  PubMed  Google Scholar 

  12. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Tucker MC, Nork SE, Simonian PT, Routt ML Jr. Simple anterior pelvic external fixation. J Trauma. 2000;49(6):989–94.

    Article  CAS  PubMed  Google Scholar 

  15. Tornetta P 3rd, Dickson K, Matta JM. Outcome of rotationally unstable pelvic ring injuries treated operatively. Clin Orthop. 1996;329:147–51.

    Article  PubMed  Google Scholar 

  16. Lindahl J, Hirvensalo E, Bostman O, Santavirta S. Failure of reduction with an external fixator in the management of injuries of the pelvic ring. Long-term evaluation of 110 patients. J Bone Jt Surg Br. 1999;81(6):955–62.

    Article  CAS  Google Scholar 

  17. Parameswaran AD, Roberts CS, Seligson D, Voor M. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma. 2003;17(7):503–7.

    Article  PubMed  Google Scholar 

  18. Enninghorst N, Toth L, King KL, McDougall D, Mackenzie S, Balogh ZJ. Acute definitive internal fixation of pelvic ring fractures in polytrauma patients: a feasible option. J Trauma. 2010;68(4):935–41.

    Article  PubMed  Google Scholar 

  19. Majeed S. Grading the outcome of pelvic fractures. J Bone Jt Surg Br Vol. 1989;71-B(2):304–6.

    Google Scholar 

  20. Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clin Orthop. 1989;242:83–97.

    PubMed  Google Scholar 

  21. Chiu F-Y, Chuang T-Y, Lo W-H. Treatment of unstable pelvic fractures: use of a transiliac sacral rod for posterior lesions and an external fixator for anterior lesions. J Trauma. 2004;57(1):141–4 discussion 4–5.

    Article  PubMed  Google Scholar 

  22. Oh C-W, Kim P-T, Kim J-W, Min W-K, Kyuung H-S, Kim S-Y, et al. Anterior plating and percutaneous iliosacral screwing in an unstable pelvic ring injury. J Orthop Sci. 2008;13(2):107–15.

    Article  PubMed  Google Scholar 

  23. Hirvensalo E, Lindahl J, Kiljunen V. Modified and new approaches for pelvic and acetabular surgery. Injury. 2007;38(4):431–41.

    Article  PubMed  Google Scholar 

  24. Keating JF, Werier J, Blachut P, Broekhuyse H, Meek RN, O’Brien PJ. Early fixation of the vertically unstable pelvis: the role of iliosacral screw fixation of the posterior lesion. J Orthop Trauma. 1999;13(2):107–13.

    Article  CAS  PubMed  Google Scholar 

  25. Palmer S, Fairbank AC, Bircher M. Surgical complications and implications of external fixation of pelvic fractures. Injury. 1997;28(9–10):649–53.

    Article  CAS  PubMed  Google Scholar 

  26. Matta JM, Tornetta P 3rd. Internal fixation of unstable pelvic ring injuries. Clin Orthop. 1996;329:129–40.

    Article  PubMed  Google Scholar 

  27. van Veen IH, van Leeuwen AA, van Popta T, van Luyt PA, Bode PJ, van Vugt AB. Unstable pelvic fractures: a retrospective analysis. Injury. 1995;26(2):81–5.

    Article  PubMed  Google Scholar 

  28. Leung KS, Chien P, Shen WY, So WS. Operative treatment of unstable pelvic fractures. Injury. 1992;23(1):31–7.

    Article  CAS  PubMed  Google Scholar 

  29. O’Flanagan SJ, Fulton G, O’Beirne J, McElwain JP. Operative fixation of unstable pelvic ring injuries in polytrauma patients. Ir J Med Sci. 1992;161(2):39–41.

    Article  PubMed  Google Scholar 

  30. Majeed SA. External fixation of the injured pelvis. The functional outcome. J Bone Joint Surg Br. 1990;72(4):612–4.

    CAS  PubMed  Google Scholar 

  31. Galois L, Pfeffer F, Mainard D, Delagoutte J-P. The value of external fixation for unstable pelvic ring injuries. Acta Orthop Belg. 2003;69(4):321–7.

    PubMed  Google Scholar 

  32. Cano-Luis P, Ricón-Recarey FJ, Lisón-Torres A, Marcos-Morales FJ. Tratamiento de las fracturas de pelvis. Rev de Ortop y Traumatol. 2006;50(3):203–16.

    Article  Google Scholar 

  33. Tee SS, Hyzan Y, Razak M. Functional outcome of open reduction and internal fixation of pelvic ring injuries. Med J Malaysia. 2000;55 Suppl C:49–58.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Sydney Medical School, The University of Sydney, Sydney, NSW, 2006, Australia

    B. Wardle & G. D. Eslick

  2. Department of Surgery, The Whiteley-Martin Research Centre, Nepean Hospital, Penrith, NSW, 2750, Australia

    G. D. Eslick

  3. Department of Orthopaedics, Nepean Hospital, Penrith, NSW, 2750, Australia

    P. Sunner

Authors
  1. B. Wardle
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  2. G. D. Eslick
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  3. P. Sunner
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Correspondence to G. D. Eslick.

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Funding

We have not received any form of funding in relation to this study.

Conflict of interest

Blaise Wardle, Guy D. Eslick, and Pavitar Sunner declare no conflict of interest.

Compliance with ethical requirements

No ethics approval was required for this study.

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Wardle, B., Eslick, G.D. & Sunner, P. Internal versus external fixation of the anterior component in unstable fractures of the pelvic ring: pooled results from a systematic review. Eur J Trauma Emerg Surg 42, 635–643 (2016). https://doi.org/10.1007/s00068-015-0554-4

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  • DOI: https://doi.org/10.1007/s00068-015-0554-4

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