Effectiveness and safety of external fixator treatment for unstable pelvic ring injury: A systematic review and meta-analysis

BACKGROUND: External fixation (EXFIX) is commonly used for managing unstable pelvic ring fractures, but its efficacy and safety remain unclear. This meta-analysis seeks to assess the efficacy and safety of EXFIX in comparison to alternative surgical interventions in patients diagnosed with unstable pelvic ring fractures. METHODS: A systematic search identified relevant studies from inception to August 2023 in PubMed, EMBASE, the Cochrane Library, and Web of Science. Data on postoperative functional and imaging evaluations were extracted as primary outcomes, with postoperative complications and survival rates as secondary outcomes, using a predefined data extraction form. The Cochrane Risk of Bias tool assessed the quality of included randomized controlled trials. Statistical analysis was performed using Stata 16.0 SE, employing Cochrane Q and I2 statistics to evaluate heterogeneity. A random effects model was used when I2 > 50% and the Q-test P-value > .05; otherwise, a fixed effects model was selected. Weighted mean differences (WMDs), risk differences (RDs), odds ratios (ORs) and their 95% confidence intervals (CIs) indicated effect size. Publication bias was assessed using funnel plots, and sensitivity analyses were conducted with the leave-one-out method. RESULTS: Of the 293 records retrieved from the database, 6 studies that met the inclusion and exclusion criteria were selected. indicated that EXFIX was associated with a significantly lower Matta excellent rate (OR = 2.01; 95% CI [1.58 to 2.56], P < .001, I2 = 54.8%) and a higher complication rate (RD = 0.19; 95% CI [0.11 to 0.27], P < .001, I2 = 0%) than other surgical interventions. No significant differences were found in the Majeed functional score (WMD = -1.87; 95% CI [-5.8 to 2.06], P = .35, I2 = 0%) and survival rate (RD = 0.03; 95% CI [-0.01 to 0.08], P = .171, I2 = 71.4%) when comparison to other surgical methods. CONCLUSION: As a viable method for controlling bleeding and stabilizing fractures initially, EXFIX has limited effect on postoperative functional recovery. It may increase the risk of complications and has a comparable impact on patient survival outcomes when compared to other surgical methods.