Efficacy and safety of different fixation methods for unstable anterior pelvic ring fractures: a Bayesian network meta-analysis.

OBJECTIVE

To evaluate the effectiveness and safety of treatment methods for unstable pelvic anterior ring fractures, aiming to provide new ideas for their treatment.

METHODS

We searched English databases including PubMed, Embase, Cochrane Library, and Web of Science, as well as Chinese databases CNKI, VIP, and Wanfang, with the search date up to September 10, 2024. The quality of the included studies was assessed using the Cochrane's Risk of Bias Tool and the Newcastle-Ottawa Scale (NOS). The effectiveness and safety of different surgical fixation methods were ranked according to probability levels. A total of 17 studies involving 1010 patients were included.

RESULTS

Compared to external fixation (ExFix), plating, screws, and internal fixator (INFIX) showed better reduction quality. Patients using plates had the highest likelihood of achieving anatomical reduction. Screw fixation was the most effective method for postoperative functional recovery. The screw group had the lowest incidence of deep vein thrombosis in the lower limbs. The plate fixation group had the lowest incidence of lateral femoral cutaneous nerve injury.

CONCLUSION

In the treatment of unstable pelvic anterior ring fractures, plating, screws, and INFIX fixation can be selected, while ExFix should only be used as a temporary fixation method.