Introduction
Material and methods
Data extraction
Assessment of risk of bias
Data analysis
Results
Complications | |||||||||||||||
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Study | Na | Ageb | Male % | Fracture type (%) | HET/LETc | Operative approach | Type of fixation | FUd | Overall % | SSI % | Implant related % | Neurological % | Non-union % | Re-operation % | |
(Modified) Stoppa approach | |||||||||||||||
Bastian et al. [16] 2016, Germany, Retrospective | 63 | 53 (16–88) | 73 | Tile B2: 11(17) Tile B3: 14 (22) Tile C1: 22 (35) Tile C2: 3 (5) Tile C3: 13 (21) | NR | Modified Stoppa | Reconstruction plate | 3.3 years (1.0–7.9) | 13 | 5 | 8 | 2 | 5 | 10 | |
Oh et al. [17] 2016, Korea, Retrospective | 22 | 41 (23–61) | 45 | LC: 12 (54) APC: 4 (18) VS: 6 (27) | High energy | Stoppa | Plate | 16 months (10–51) | 0 | 0 | 0 | 0 | NR | NR | |
Percutaneous approach | |||||||||||||||
Chen et al. [18] 2012, China, Retrospective | Group A: 29 | Group A: 37 (11) | Group A: 69 | Tile C1: 19 (33) Tile C2: 8 (14) Tile C3: 2 (3) | NR | ORIFa | Group A: reconstruction plate | 23.81 Days (± 6.18) | 0 | 0 | 0 | 0 | NR | 0 | |
Group B: 29 | Group B: 39 (10) | Group B: 72 | Tile C1: 21 (36) Tile C2: 6 (11) Tile C3: 2 (3) | NR | Percutaneous | Group B: sacroiliac screws | 23.94 days (± 6.03) | 7 | 0 | 0 | 7 | NR | 7 | ||
Dekimpe et al. [19] 2020, France, Retrospective | 32 | 46 (24–80) | NR | Tile B: 7 (22) Tile C: 23 (78) | NR | Percutaneous | Sacroiliac and acetabular screws | 13.5 months (4–30) | 9 | 0 | 9 | NR | NR | 6 | |
Falzarano et al. [20] 2018, Italy, Retrospective | 96 | 37 (19–63) | Tile C: 96 | High energy | Percutaneous | Sacroiliac screws | NR (1 – 60 months) | 12 | 12 | 0 | NR | 0 | 2 | ||
Li et al. [21] 2014, China, RCT | Group A: 32 Group B: 32 | Group A: 39 (22–57) Group B: 37.3 (21–55) | Group A: 78 Group B:75 | Tile C1: 22 (35) Tile C2: 8 (12) Tile C3: 2 (3) Tile C1: 23 (36) Tile C2: 8 (12) Tile C3: 1 (2) | High energy High energy | Percutaneous | Group A: Sacro iliac screws Group B: Control, Sacro iliac Anterior plate fixation | NR NR | 3 9 | 3 9 | 0 0 | 0 0 | NR NR | 3 NR | |
Osterhoff et al. [22] 2011, Switzerland, Retrospective | 25 | 56 (20) | LC I and LC II or Tile B2 | NR | Percutaneous | Sacroiliac screws | 6 months (6–4) | 16 | 0 | 8 | NR | 8 | 24 | ||
Rommens et al. [23] 2020, Germany, Retrospective | 128 | Median 69 (51–81) | 33 | FFP 1: 1 (1) FFP 2: 38 (30) FFP 3 : 11 (9) FFP 4: 15 (12) Tile B: 36 (128) Tile C:27 (21) | High energy 63 Low energy 65 | Percutaneous | Transpubic screws | 27.6 weeks (7.0–73.5 weeks) | 12 | 2 | 7 | 0 | 6 | 8 | |
Wenning et al. [24] 2021, Germany, Retrospective Comparative | Group A: 48 Group B: 29 | Group A: 79 (14) Group B: 62 (18) | Group A: 17 Group B: 41 | Tile C0: 22 (29) Tile C2: 26 (34) Tile C3: 0 Tile C0: 15 (19) Tile C2: 0 Tile C3: 14 (18) | NR NR | Percutaneous Open | Group A: Sacroiliac screws Group B:Lumbo pelvic fixation | At least 6 months At least 6 months | 13 18 | 2 14 | 11 4 | NR NR | 0 4 | 13 18 |
Complications | ||||||||||||||
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Study | Na | Ageb | Male % | Fracture type (%) | HET/LETc | Operative approach | Type of fixation | FUd | Overall % | SSI % | Implant related % | Neurological % | Non-union % | Re-operation % |
(Modified) Stoppa approach | ||||||||||||||
Khoury et al. [29] 2012, Israel, Retrospective | 60 | NR | NR | NR | NR | Modified Stoppa | Plate and/or screws | NR | 25 | 5 | NR | 0 | NR | NR |
Isaacson et al. [30] 2014, USA, Retrospective | 36 | 47 (16) | 86 | AC: 1 (3) Trans: 5 (14) T-type: 6 (17) TPW: 2 (6) ACPH: 7 (19) BC: 15 (42) | High Energy | Modified Stoppa | Plate and/or screws | 32 months (9–59) | 17 | 8 | NR | 6 | 6 | 8 |
Singh et al. [31]2020, India, Retrospective | 30 | 40 (18–60) | 80 | AC: 3 (10) T-type: 1 (3) TPW: 1 (3) ACPH: 6 (20) BC: 19 (63) | High energy | Modified Stoppa | Plate and/or screws | 6 months (NR) | 17 | 3 | NR | 6 | NR | NR |
Verbeek et al. [32] 2018, Netherlands, Retrospective | 45 | 51 (17) | 71 | AW: 3 (7) Trans: 8 (18) T-type: 16 (36) ACPH: 5 (11) BC: 13 (29) | High energy 69% Low energy 31% | Modified Stoppa | Plate and/or screws | 59 months (12–165) | 9 | 4 | 2 | NR | NR | 8 |
Kocher-Langenbeck approach | ||||||||||||||
Alexa et al. [33] 2013, Romania, Retrospective | 42 | 41 (26–71) | 69 | PW: 9 (21) PC: 3 (7) PCW: 4 (10) Trans: 11 (26) T-type: 5 (12) TPW: 10 (24) | High energy | KL | Plate and (non-specified) screws: 39 (non-specified) Screws only: 3 | NR (1–4 years) | 9 | 2 | NR | 7 | NR | 5 |
Iqbal et al. [34]e 2017, Pakistan, Retrospective | 170 | 45 (22) | 59 | NR | NR | KL | Reconstruction plate | At least 12 months (NR) | 5 | 3 | NR | NR | 0 | NR |
Negrin et al. [35] 2010, Austria, Retrospective | 27 | A: 40 (10) B: 42 (20) | 41 | Trans: 27 | NR | KL | Plate osteosynthesis | 9 months (± 6) | 12 | 0 | 0 | 12 | NR | 15 |
Suzuki et al. [36] 2009, USA, Retrospective | 326 | 43 (18) | 77 | PW: 78 (23.9) PC: 7 (2.1) AW: 1 (0.5) AC: 22 (6.7) PCW: 16 (4.9) Trans: 29 (8.9) T-type: 35 (10.7) TPW: 48 (14.7) ACPH: 21 (6.4) BC: 69 (21.2) | NR | KL | Plate and/or screws | NR | 5 | 5 | NR | NR | 0 | 5 |
Kumar et al. [37] 2021, India, Retrospective | 80 | 43 (13) | 60 | PW: 27 (34) PC: 16 (20) PCW: 9 (11) Trans: 7 (9) T-type: 9 (11) TPW: 7 (9) ACPH: 5 (6) | High Energy | KL | Plate and/or screws | mean 2.6 years (SD) | 3 | 1 | NR | 2 | NR | NR |
Ilioinguinal approach | ||||||||||||||
Iqbal et al.[34]e 2017, Pakistan, Retrospective | 45 | 45 (22) | 59 | NR | NR | Ilioinguinal | Reconstruction plate | At least 12 months (NR) | 7 | 7 | NR | NR | NR | NR |
Study | Aim of the study | Inclusion of consecutive patients | Prospective collection of data | Endpoint appropriate to the study aim | Unbiased evaluation of endpoints | F/U period appropriate to the major endpoint | Loss to F/U not exceeding 5% | Sample size calculation | Additional criteria | ||||
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Adequate control group | Contemporary groups | Baseline equivalence of groups | Adequate statistical analyses | Total score | |||||||||
Bastian et al. [16] | 2 | 1 | 0 | 2 | 0 | 2 | 2 | 1 | NA | NA | NA | NA | 10/16 |
Oh et al. [17] | 2 | 2 | 0 | 2 | 0 | 2 | 1 | 1 | NA | NA | NA | NA | 10/16 |
Chen et al. [18] | 2 | 2 | 0 | 2 | 0 | 2 | 2 | 1 | 0 | 2 | 2 | 1 | 16/24 |
Dekimpe et al. [19] | 2 | 1 | 0 | 2 | 0 | 2 | 2 | 1 | NA | NA | NA | NA | 10/16 |
Falzarano et al. [20] | 1 | 0 | 0 | 2 | 0 | 2 | 0 | 0 | NA | NA | NA | NA | 5/16 |
Li et al. [21] | 2 | 2 | 2 | 2 | 1 | 2 | 2 | 1 | 2 | 2 | 2 | 1 | 21/24 |
Osterhoff et al. [22] | 2 | 1 | 0 | 2 | 0 | 1 | 0 | 1 | NA | NA | NA | NA | 7/16 |
Rommens et al. [23] | 2 | 1 | 0 | 2 | 0 | 1 | 0 | 0 | NA | NA | NA | NA | 6/16 |
Wenning et al. [24] | 2 | 2 | 2 | 2 | 0 | 2 | 1 | 0 | 1 | 1 | 1 | 2 | 16/24 |
Scaglione et al. [25] | 1 | 1 | 0 | 2 | 0 | 0 | 0 | 0 | NA | NA | NA | NA | 4/16 |
Post-operative complications per fracture type
Post-operative complications per surgical approach
(Modified) Stoppa approach
Overall complications, % | SSI, % | Implant related, % | Neurological, % | Non-union, % | Re-operations, % | |
---|---|---|---|---|---|---|
(Modified) Stoppa approach | 17.3 | 5.5 | 4.6 | 2.5 | 7.2 | 5.2 |
Percutaneous (Screw) | 11.0 | 4.4 | 4.4 | 1.1 | 3.3 | 7.5 |
External fixator | 31.1 | 22.1 | 12.9 | 31.0 | 0 | 4.3 |
Kocher Langebeck approach | 5.4 | 3.1 | 0 | 5.2 | 0 | 6.2 |
Illioinguinal approach | 7.0 | 7.0 | NR | NR | NR | NR |
Study | SSI, n (%) | Implant related, n (%) | Neurological complications, n (%) | Non-union, n (%) | Additive fixation, n (%) | Hematoma, n (%) | Secondary placement THP, n (%) | Other, n (%) | Specification |
---|---|---|---|---|---|---|---|---|---|
(Modified) Stoppa | |||||||||
Bastian et al. [16] | 3 (50) | 1a (16.7) | 1 (16.7) | 1b (16.7) | aIntra-articular screw bAbdominal wall hernia | ||||
Isaacson et al. [30] | 3 (100) | ||||||||
Verbeek et al. [32] | 2 (50) | 1 (25) | 1a (25) | aRevision surgery due to loss of reduction | |||||
Overall, n (%) | 13 (69.2) | 1 (7.7) | 2 (15.4) | 1 (7.7) | |||||
Percutaneous approach | |||||||||
Chen et al. [18] | 2 (100) | Screw replacement due to neurological complication | |||||||
Dekimpe et al. [19] | 2 (100) | Screw removal due to irritation | |||||||
Falzerano et al | 2 (100) | Screw removal due to mobilization of material | |||||||
Li et al. [21] | 1 (100) | ||||||||
Osterhoff et al. [22] | 2a (33.3) | 2 (33.4) | 2 (33.3) | aNerve irritation | |||||
Rommens et al. [23] | 2 (25) | 2a (25) | 1 (12.5) | 1 (12.5) | 2b (25) | aMalposition of screws bInfection and nonunion | |||
Wenning et al. [24] | 1 (16.7) | 5a (83.3) | aMal position of screws | ||||||
Overall, n (%) | 4 (14.8) | 9 (33.4) | 6 (22.2) | 3 (11.1) | 2 (7.4) | 1 (3.7) | 2 (7.4) | ||
External fixator | |||||||||
Scaglione et al. [25] | 3 (100) | ||||||||
Mean, n (%) | 3 (100) | ||||||||
Kocher Langenbeck | |||||||||
Alexa et al. [33] | 1 (50) | 1 (50) | |||||||
Negrin et al. [35] | 4 (100) | ||||||||
Susuki et al. [36] | 2 (100) | ||||||||
Overall, n (%) | 3 (37.5) | 5 (62.5) |