Pelvic ring disruptions: treatment modalities and analysis of outcomes

Abstract

A systematic review of the English literature over the last 30 years was conducted in order to investigate the correlation of the clinical outcome of different types of pelvic ring injuries to the method of treatment. Three basic therapeutic approaches were analysed: non-operative treatment (group A), stabilisation of anterior pelvis (group B) and internal fixation of posterior pelvis (group C). Of 818 retrieved reports, 27 case series, with 28 groups of patients and 1,641 patients, met our inclusion criteria. The quality of the literature was evaluated using a structured questionnaire. Outcomes of the eligible studies were summarised by the medians of the reported results. Most of the component studies were of fair or poor quality. Certain radiological results (quality of reduction, malunion rates) were significantly better in group C. From the functional point of view only walking capacity was proved to be significantly better in the groups of operative treatment compared to the non-operative group.

Figures

Fig. 1

The different classification schemes and the correlation of their subgroups between each other

Fig. 2

The improvement of the reported data of the reviewed studies in time. The linear regression analysis of the quality score of these studies showed an increase of 0.2 points per year (median score: 5, range: 2-8). In Table 3 the median score is presented grouped per different method of treatment (groups A, B and C)

Fig. 3

The incidence of poor residual reduction (anteroposterior translation or vertical displacement > 10 mm and/or diastasis of pubic symphysis > 25 mm) in the three different groups showed statistical significant differences (p = 0.004). In the non-operative group (group A) poor quality reduction was recorded in 38.5%, in comparison to 19% in the “anterior pelvic fixation” (group B), and only 7% in the “posterior fixation group (group C). The grey areas on the chart represent the above rates of poor quality of reduction in the three groups

Fig. 4

The incidence of malunions (leg length discrepancy > 1 cm, obvious malrotation or “poor” quality of reduction) as recorded in the three different treatment groups showed statistically significant differences (p = 0.02). In the non-operative group (group A) malunions were recorded in 30.3%, in comparison to 42% in the “anterior pelvic fixation” (group B), and only 7% in the “posterior fixation group (group C). The grey areas on the chart represent the above rates of malunion in the three groups

Fig. 5

The incidence of undisturbed gait was evaluated as one of the criteria of long-term functional outcome. A comparison between the two operative groups (B and C) and the non-operative group A showed a statistically significant difference (p = 0.04). In the non-operative group (group A) undisturbed gait was recorded in only 68%, in comparison to 84 and 84.5%, respectively. The grey areas on the chart represent the above rates of undisturbed gait in the three groups