Operative Treatment Of Unstable Pelvic Fractures: A Meta-analysis

Objective: We have carried out a comprehensive review of the literature concerning the surgical management of unstable pelvic fractures and subjected it to a meta-analysis in order to assess the method of the fracture fixation ,the incidence of post-operative complications ,the quality of reduction and the functional outcome.Methods: Search were applide to the following electronic database: Medline (1950—2007.2) use ovid search engine, etc.A manual search was done to the major orthopaedic journals ,such as《clinical orthopaedics & related research》etc.Data ectraction by hand and data statistics by spss on a personal computer.Results: The average ISS scoring of unstable pelvic fracture was 24.0 point,the incidence of neurological injury was 16.2%,and the incidence of other injurys was 9.4% to 40.0% . In the posterior ring fixation, Percutaneous fixation with sacro-iliac screw was used in 41.5% of patients,and the percent of other method was 5.1% to 22.6%. The incidence of post-operative complications associated with external fixator was high(pin infection 22.6%, loosening of the pin 19.1%), and other complications were haphazard.The quality of reduction,55.7% of them got anatomical or nearly anatomical reduction.After the average follow-up time of 28.8 months, only 61.1% of the patients get satisfactory results according to the majeed fuctional score,and 45.2% of patient have pain.Conclusion: The unstable pelvic fractures is very difficult to treatment as a severe trauma. Pure external fixator cannot be choose to denfinit treament of unstable pelvic fractures,and Percutaneous technique become the primary method of the fixation technique.Although satisfaction in the quality of reduction and the safety of operative treatment was got ,but the long term follow-up show that the functional outcome was still unsatisfactory. Objectives: The operative treatment is the dominating treatment of unstable pelvic fractures,and the fixation of posterior ring is the keystone. There are a variety of methods available, including iliosacral screws, sacral bars, and anterior and posterior plating techniques. Percutaneous technique with iliosacral screws become the primary method of the fixation technique.so we evaluated the effectiveness of Percutaneous fixation with iliosacral screw in the management of the unstable pelvic fractures in Huaxi hospital..Methods: In 2003-2007,there is 15 unstable pelvic fractures were treated using Percutaneous fixation with iliosacral screws in Huaxi hospital. Anterior fixation was by means of plating in 3 cases ,by external fixation in 7 cases,by both in 5 cases. Complications were recorded and radiographs were analyzed with Matta criterion to classify fractures and identify screw misplacement and malunion. All patients had a functional evaluation according to Majeed functional scoring.Results: Neither nerve injury nor other perioperative complications was found ,the quality of the fracture reduction was graded as excellent in 14 cases and satisfactory in 1 according to Matta criterion. After the average follow-up time of 28.8 months ,all fracture union , Screw loosing occurred in one patients but there were no adverse sequelae ,12 (80 percent) had no pain, slight limp was found in one patient .9 (60 percent) returned to their pre-injury occupation, six patients (15 percent) changed occupation, and nine patients (15 percent) had not yet returned to work by last follow-up. There was 11 excellent(73.3 percent) and 4 good (36.7 percent)according to Majeed functional scoring.Conclusions: Iliosacral screw fixation is a useful method of fixation in the unstable pelvic fracture.But the clinic value of percutaneous iliosacral screws need more clinic study since there is few cases and little follow-up time in our report.