Effectiveness of surgical fixation for lateral compression type one (LC-1) fragility fractures of the pelvis: a systematic review

Booth, Alison L.; Ingoe, Helen; Northgraves, Matthew; Coleman, Elizabeth Ann; Harden, Melissa; Kassam, Jamila; Kwok, Iris H.Y.; Hilton, Catherine; Bates, Peter; McDaid, Catriona

doi:10.1136/bmjopen-2018-024737

Cited by 16 publications

(11 citation statements)

References 39 publications

(68 reference statements)

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“…We noted a previous systematic review of four studies on the effectiveness of surgical fixation of osteoporotic LC1 fractures. This found insufficient evidence to support guidance on the most effective treatment for patients sustaining this injury however where reported, mobility and function did improve after surgery [ 59 ]. This systematic review is a more comprehensive overview of 17 studies encompassing all types of FFP.…”

Section: Discussionmentioning

confidence: 99%

Operative management of fragility fractures of the pelvis – a systematic review

Wilson

Kelly

Rickman

2021

BMC Musculoskelet Disord

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Background The incidence of osteoporotic pelvic fractures in elderly patient is rising. This brings an increasing burden on health and social care systems as these injuries often lead to prolonged hospital admissions, loss of independence, morbidity and mortality. Some centres now advocate stabilisation of these injuries to reduce pain, facilitate early mobilisation, decrease hospital stay and restore independence. A systematic review of the literature was planned to establish the evidence for this intervention. Methods A systematic review was performed according to PRISMA guidelines. A clinical librarian performed a search of the following databases: NHS Evidence, TRIP, the Cochrane Database of Systematic Reviews, MEDLINE and EMBASE. Seventeen eligible studies were identified with 766 patients. Results The quality of evidence was poor with no good quality randomised trials. The majority of injuries were minimally displaced. Posterior ring injuries were most often stabilised with percutaneous screws which were sometimes augmented with void filler. A number of techniques were described for stabilisation of the anterior ring although fixation of the anterior ring was frequently not performed. There was consistent evidence from the included studies that operative intervention significantly improved pain. Complications were minimal but there were increased failure rates when a single unaugmented sacroiliac joint screw was used. The limited availability of non-operative comparators made it difficult to draw firm conclusions about the efficacy of surgical over non-surgical management in these patients. Conclusions Operative management of fragility fractures of the pelvis should be considered for patients failing a brief period of non-operative management, however prospective randomised trials need to be performed to provide improved evidence for this intervention. Surgeons should consider which fixation techniques for fragility fractures of the pelvis are robust enough to allow immediate weightbearing, whilst minimising operative morbidity and post-operative complications. PROSPERO Systematic Review ID: CRD42020171237.

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Section: Discussionmentioning

confidence: 99%

Operative management of fragility fractures of the pelvis – a systematic review

Wilson

Kelly

Rickman

2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…We noted a previous systematic review of four studies on the effectiveness of surgical xation of osteoporotic LC1 fractures. This found insu cient evidence to support guidance on the most effective treatment for patients sustaining this injury however where reported, mobility and function did improve after surgery [59]. This systematic review is a more comprehensive overview of 17 studies encompassing all types of FFP.…”

Section: Discussionmentioning

confidence: 95%

Operative Management of Fragility Fractures of the Pelvis – A Systematic Review

Wilson

Kelly

Rickman

2021

Preprint

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BackgroundThe incidence of osteoporotic pelvic fractures in elderly patient is rising. This brings an increasing burden on health and social care systems as these injuries often lead to prolonged hospital admissions, loss of independence, morbidity and mortality. Some centres now advocate stabilisation of these injuries to reduce pain, facilitate early mobilisation, decrease hospital stay and restore independence. A systematic review of the literature was planned to establish the evidence for this intervention.MethodsA systematic review was performed according to PRISMA guidelines. A clinical librarian performed a search of the following databases: NHS Evidence, TRIP, the Cochrane Database of Systematic Reviews, MEDLINE and EMBASE. 17 eligible studies were identified with 766 patients. ResultsThe quality of evidence was poor with no good quality randomised trials. The majority of injuries were minimally displaced. Posterior ring injuries were most often stabilised with percutaneous screws which were sometimes augmented with void filler. A variety of techniques were described for stabilisation of the anterior ring although fixation of the anterior ring was frequently not performed.There was consistent evidence from the included studies that operative intervention significantly improved pain. Complications were minimal but there were increased failure rates when a single unaugmented sacroiliac joint screw was used. The limited availability of non-operative comparators made it difficult to draw firm conclusions about the efficacy of surgical over non-surgical management in these patients. ConclusionsOperative management of fragility fractures of the pelvis should be considered for patients failing a brief period of non-operative management, however prospective randomised trials need to be performed to provide improved evidence for this intervention. Surgeons should consider which fixation techniques for fragility fractures of the pelvis are robust enough to allow immediate weightbearing, whilst minimising operative morbidity and post-operative complications.PROSPERO Systematic Review ID: CRD42020171237

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“…A systematic review found no robust evaluations, particularly randomised controlled trials (RCTs), of the effectiveness of internal fixation with INFIX in patients with osteoporotic LC-1 fractures [ 23 ]. The review identified five case series, with four being retrospective.…”

Section: Introductionmentioning

confidence: 99%

Lateral compression type 1 fracture fixation in the elderly (L1FE): study protocol for a randomised controlled trial (with internal pilot) comparing the effects of INFIX surgery and non-surgical management for treating patients with lateral compression type 1 (LC-1) fragility fractures

Cook

Laycock

Acharya

et al. 2023

Trials

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Background Lateral compression type1 (LC-1) fragility fractures are a common, painful injury in older adults resulting in reduced mobility. The incidence of these fractures is increasing with the growing older adult population. The current standard of care is non-surgical management; however, patients with this injury are at risk of long-term immobility and related complications. INFIX is a pelvic fixation device used in younger patients with high-energy fractures. The device is fitted via a percutaneous technique with no external pin sites and has good purchase even in osteoporotic bone. It therefore has the potential to be well tolerated in patients with LC-1 fragility fractures. INFIX could improve patients’ ability to mobilise and reduce the risk of immobility-related complications. However, there is a risk of complications related to surgery, and robust evidence is required on patient outcomes. This study will investigate the clinical and cost-effectiveness of surgical fixation with INFIX compared to non-surgical management of LC-1 fragility fractures in older adults. Methods A multi-centre randomised controlled trial of 600 patients allocated 1:1 to non-surgical management or INFIX surgery. The study will have a 12-month internal pilot to assess recruitment and trial feasibility. The primary outcome will be the patient quality of life over 6 months, measured by the patient-reported EQ-5D-5L. The secondary outcomes will include physical function, mental health, pain, delirium, imaging assessment, resource use, and complications. Discussion The L1FE study aims to compare the clinical and cost-effectiveness of surgical and non-surgical management of people aged 60 years and older with LC-1 fragility fractures. The trial is sufficiently powered and rigorously designed to inform future clinical and patient decision-making and allocation of NHS resources. Trial registration International Standard Randomised Controlled Trial Number Registry ISRCTN16478561. Registered on 8 April 2019

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Effectiveness of surgical fixation for lateral compression type one (LC-1) fragility fractures of the pelvis: a systematic review

Cited by 16 publications

References 39 publications

Operative management of fragility fractures of the pelvis – a systematic review

Operative management of fragility fractures of the pelvis – a systematic review

Operative Management of Fragility Fractures of the Pelvis – A Systematic Review

Lateral compression type 1 fracture fixation in the elderly (L1FE): study protocol for a randomised controlled trial (with internal pilot) comparing the effects of INFIX surgery and non-surgical management for treating patients with lateral compression type 1 (LC-1) fragility fractures

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