Introduction
Methods
Levels of evidence
| |
I
| RCTs and/or systematic review or metanalysis of RCTs |
II
| A single well designed RCT |
III
| Cohort studies with concurrent or historical controls or their metanalysis |
IV
| Case control studies or their metanalysis |
V
| Case series without controls |
VI
| Expert opinion, guidelines, documents coming from consensus conference |
Grade of recommendations
| |
A
| Highly recommended. From good quality level, even if not level I-II |
B
| Not always recommended but must be taken in consideration |
C
| Substantial uncertainty in favour or against |
D
| Not recommended |
E
| Highly not recommended |
Results and discussion
Reference | Year | Design | Patients | Comments | |
---|---|---|---|---|---|
1 | Burgess [1] | 1990 | Prospective | 25 unstable | Acute external fixation and angio |
2. | Flint [10] | 1990 | Prospective observational | 60 | Use of PASG, 37/60 had ORIF within 24 hrs, only 4 ext fix |
3. | Latenser [11] | 1991 | Prospective with historical controls | 18/19 | Early defined as internal or external fixation within 8 hrs from arrival |
4. | Broos [12] | 1992 | Retrospective | 44 type B and C fractures | Immediate fixation |
5. | Gruen [13] | 1994 | Retrospective | 36 unstable | Angio and anterior urgent ORIF [within 2-3 days] |
6. | Van Veen [14] | 1995 | Retrospective | 9 unstable | Peritoneal packing, bilateral ligation of internal iliac artery, EF and/or ORIF within 6 hours |
7. | Heini [15] | 1996 | Retrospective | 18 unstable | C clamp placement |
8. | Bassam [16] | 1998 | Prospective observational | 15 unstable | External fixation first if anterior fracture, angio first if posterior fracture |
9. | Velmahos [17] | 2000 | Retrospective | 30 unstable | Bilateral embolization of iliac internal artery |
10. | Wong [18] | 2000 | Retrospective | 17 unstable | External fixation and angio, either before or after |
11. | Biffl [19] | 2001 | Observational with historical controls | 50/38 systolic blood pressure < 90 | Use of angio and early external fixation or C clamp |
12. | Ertel [20] | 2001 | Retrospective | 20 | Use of C clamp and pelvic packing |
13. | Cook [21] | 2002 | Retrospective | 74 unstable [23 underwent angio] | Exernal fixation and angio |
14. | Kushimoto [22] | 2003 | Retrospective | 29 mixed population | Angio before and after Damage Control Laparotomy. No pelvic packing or external fixation. High mortality. |
15. | Miller [23] | 2003 | Retrospective | 35 unstable | Angio and then external fixation. If laparotomy first angio done after external fixation |
16. | Hagiwara [24] | 2003 | Prospective | 61 stable and unstable | Angio and then external fixation in the angio suite |
17. | Ruchholtz [25] | 2004 | Prospective | 21 unstable | Early external fixation in mechanically unstable fractures |
18. | Fangio [26] | 2005 | Retrospective | 32 unstable | Angio first usually. No packing. Laparotomy before or after angio. Some external fixation |
19. | Sadri [27] | 2005 | Retrospective | 14 unstable | C clamp and then angio |
20. | Krieg [28] | 2005 | Prospective | 16 unstable | Outcomes following pelvic belt |
21. | Croce [29] | 2007 | Retrospective | 186 [stable and unstable] | Use of External fixation or T-POD® and angio |
22. | Lai [30] | 2008 | Retrospective | 7 unstable | External fixation and angio |
23. | Richard [31] | 2009 | Prospective | 24 APC-2 pelvic injuries [11 unstable] | Anteriorly placed C-clamp [in the ER, angio suite or OR] |
24. | Morozumi [32] | 2010 | Retrospective | 12 unstable | Mobile angio first. No packing or fixation |
25. | Jeske [33] | 2010 | Retrospective | 45 unstable | External fixation and angio |
26. | Enninghorst [34] | 2010 | Retrospective | 18 unstable | Acute ORIF [< 24 hrs] |
27. | Tan [35] | 2010 | Prospective | 15 unstable | Application of T-POD® |
28. | Cherry [36] | 2011 | Retrospective | 12 unstable | OR angio. |
29. | Karadimas [37] | 2011 | Retrospective | 34 mixed population | External fixation and secondary angio. |
30. | Hornez [38] | 2011 | Retrospective | 17 unstable | Pelvic packing, angio and fixation. |
31. | Fang [39] | 2011 | Retrospective | 76 unstable | Mixed population [60% unstable fractures]. Angio and/or laparotomy. No packing. |
32. | Tai [40] | 2011 | Retrospective | 24 unstable | Shift to pelvic packing and external fixation before angio |
33. | Burlew [41] | 2011 | Prospective | 75 | Preperitoneal pelvic packing and external fixation in emergency. Secondary angiography |
34. | Fu [42] | 2012 | Retrospective | 28 unstable | Angio [available 24 hrs] directly if negative FAST. Intraperitoneal packing. No fixation. |
35. | Hu [43] | 2012 | Retrospective | 15 unstable | External fixation |
36. | Metsemakers [44] | 2013 | Retrospective | 98 unstable | External fixation first, no pelvic packing for closed fractures. Then angio [13 embolized out of 15 angio done] |
37. | Abrassart [45] | 2013 | Retrospective | 70 unstable | 4 groups with either external fixation only, together with angio, laparotomy or angio before external fixation |