Operative Treatment of Sacral Fractures with Traumatic Spino-Pelvic Dissociation: A Systematic Review and Meta-analysis.

Abstract

Background: The therapy of sacral fractures accompanied by traumatic spino-pelvic dissociation (SPD) poses considerable problems owing to the intricate nature of the injuries and the diverse surgical procedures available. Two principal fixation techniques, iliosacral fixation and posterior pelvic fixation, are frequently utilized. The comparative results and complication rates between various methods remain ambiguous. Methodology: A systematic review and meta-analysis were performed to evaluate outcomes, complication rates, and intraoperative parameters (including blood loss and operation duration) between iliosacral fixation and posterior pelvic fixation. Research conducted from 2001 to 2024 was located by an exhaustive search of databases such as PubMed, Embase, Scopus, and Google Scholar. Data from pertinent studies were retrieved and analyzed utilizing Review Manager (RevMan version 5.4.1). Odds ratios (ORs) and standardized mean differences (SMD) with 95% confidence intervals (CIs) were computed to assess the outcomes. Results: A total of 13 papers were incorporated in the meta-analysis, contrasting the Ilio-sacral and Posterior pelvic fixation cohorts. The pooled analysis indicated no statistically significant difference in complication rates between the two groups (OR: 0.64 [0.27, 1.51], p = 0.30), exhibiting low to moderate heterogeneity (I² = 29%). Furthermore, there was no notable difference in overall outcomes between the two groups (OR: 0.64 [0.27, 1.51], p = 0.30). Conclusion: Both Ilio-sacral fixation and Posterior pelvic fixation offer comparable outcomes and complication rates in the surgical management of sacral fractures with SPD. Nonetheless, posterior pelvic fixation seems to correlate with markedly decreased intraoperative blood loss.