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Review
. 2022 Sep 16;14(9):e29239.
doi: 10.7759/cureus.29239. eCollection 2022 Sep.

Surgical Versus Non-surgical Treatment of Unstable Lateral Compression Type I (LC1) Injuries of the Pelvis With Complete Sacral Fractures in Non-fragility Fracture Patients: A Systematic Review

Jonny R Varma  1 , Michael Foxall-Smith  1 , Richard L Donovan  2 , Michael R Whitehouse  3 , Chris Rogers  3 , Mehool Acharya  1
Affiliations
Review

Surgical Versus Non-surgical Treatment of Unstable Lateral Compression Type I (LC1) Injuries of the Pelvis With Complete Sacral Fractures in Non-fragility Fracture Patients: A Systematic Review

Jonny R Varma et al. Cureus. .

Abstract

Lateral compression type 1 (LC1) injuries comprise two-thirds of pelvic fractures. Approximately one-third of LC1 fractures are unstable and may benefit from surgical fixation to improve stability but it is not clear if this leads to better clinical or cost-effectiveness outcomes. This study explores differences in patient-reported outcomes, complications, time-to-mobilisation, cost-effectiveness, and length of hospital stay between surgically and non-surgically treated unstable LC1 non-fragility fractures. We performed a systematic review to determine whether surgical or non-surgical treatment yielded better clinical and cost-effectiveness outcomes for the treatment of unstable LC1 pelvic injuries with complete sacral fractures, excluding fragility fractures. We searched Medline, Embase and Cochrane databases from inception to June 2022, as well as clinical trial registries. A formal meta-analysis was not possible due to available study designs and heterogeneity. Therefore, a narrative review of the findings has been provided. Five observational studies met the inclusion criteria. A total of 183 patients were treated surgically, and 314 patients were treated non-surgically. Patients treated surgically had lower pain levels (Visual Analogue Scale) and fewer days to mobilisation. Quality of life (EuroQol-5 domains and 36-Item Short Form questionnaires) was better in the surgical group, but not statistically significant. No statistical differences in the length of hospital stay or complication rates were found. This review highlights the low quantity and quality of existing data on patients with unstable LC1 pelvic fractures and the need for a definitive randomised controlled trial to determine whether surgical or non-surgical care should be the preferred treatment concerning clinical and cost-effective care.

Keywords: closed pelvic fracture; pelvic ring; pelvic ring injury; pelvic surgery; screw fixation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flowchart.
PRISMA: Preferred Reporting Items for Systematic Review and Meta-Analysis
Figure 2
Figure 2. Risk of bias scoring.
[15-19].
Figure 3
Figure 3. Risk of bias scoring.
See this image and copyright information in PMC

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