Table 1.

Study characteristics

Author (year) Study site	Inclusion/exclusion criteria	Patient descriptors	Injuries documented and accounted for	Fracture classification	Cause of fracture and frequencies (eg, fall)	Fixation type	Time to surgery (days) Operation time (minutes) Post-op regime	Follow-up time points
Arduini et al 34 Italy Retrospective case series	Surgery for fragility fracture of the pelvis. Indications for surgery include: chronic lower limb pain or lower back pain with no other diagnosis following traditional treatment Exclusion Not reported	Screened Not reported Sample size 14 Mean age (SD) 69.6 Gender 9F:5M Comorbidities Osteoporosis = 5 taking bisphosphonates	Concurrent None reported Previous Undisplaced anterior ring pelvic fracture in the previous 2 years = 4 Other pelvic ring fracture = 2	Rommens type II = 3, type III = 9, type IV = 2	Low energy = 6 Spontaneous pain = 8	SI screws and symphysis plate or pubic rami screw = 8 Trans-sacral bridge plate and SI screws = 3 Lumbar-pelvic fixation and symphysis plate = 3	Time to surgery 6 Months Operation time Range 70 to 220 mins Postop Regime Bed rest for 4 to 6 weeks and partially weight-bearing for a further 6 to 8 weeks	Primary: 6 months Secondary: 1 and 3 months
Gänsslen et al 33 Germany Case series: data collected prospectively patients identified from database postoperatively	Patients ≥65 years with type B injuries stabilised by a supra-acetabular external fixator in a standardised technique were selected from the hospital pelvic database of all patients with pelvic ring and acetabular injuries. Exclusion Not reported	Screened Not reported Sample size 25 Mean age (SD) 79.3 (9.9) (range 66 to 99) Gender F23:M2 Comorbidities At least one significant co-morbidity = 19 (76%), most had two including hypertension, chronic heart disease or osteoporosis	Concurrent isolated pelvic trauma = 21 distal radius fracture and/or minor head injury = 4 Previous None reported	AO B 2.1 = 24 B 3.3 = 1 A 3.3 = 1	Low energy = 22 High energy = 3	Supra-acetabular external fixation	Time to surgery Mean (SD) 3.6 (3.3) (range 0 to 13) Operation time Mean (SD) = 19 (7.4) (range 9 to 35) Postop Regime Fully weight-bearing = 14 Partial weight-bearing on the affected sacral side = 4 Partial weight-bearing = 7	Primary: postoperative discharge Secondary: removal of external fixator
Höch et al 36 Germany Retrospective case series	Over 65 years, with a lateral compression fracture of the pelvis Exclusion Not reported	Screened Not reported Sample size 128 Mean age (SD) Overall 81 (8.3) Non-Operative 82.7 (7.9) Operative 78.3 (7.6) Died before treatment 92 P <0.002 Gender Overall F109:M19 Non-operative F66:M11 Operative F42:M8 Died before treatment F1:M0 Comorbidities Overall ASA 2.7 (SD 0.5) Non-operative ASA 2.8 (SD 0.6) Operative ASA 2.6 (SD 0.5)	Concurrent Overall ISS 10.1 (SD 4.6), isolated 89, additional injury ISS <16=31, ISS >16 = 8 Non-operative ISS 10.0 (SD 3.9), isolated 56, additional injury ISS <16 = 15, ISS >16 = 6 Operative ISS 9.4 (SD 2.1), isolated 33, additional injury ISS <16=16, ISS >16 = 1 Died before treatment ISS 48, ISS >16 = 1 Previous Not reported	AO B2.1=115 (90%) B3.3=13 (10%) Unilateral pubic rami = 117 (91%) Bilateral = 11 (9%) Complex pelvic fractures = 2	Overall Low energy = 103 High energy = 13 Unknown = 12 Non-Op Low energy = 63 High energy = 7 Unknown = 7 Operative Low energy = 40 High energy = 5 Unknown = 5 Died before treatment High energy = 1	Unilateral iliosacral screw fixation = 28 S1 screws x2 = 4 S1+S2 screw = 2 Bilateral iliosacral screws = 14 Additional percutaneously sacroplasty = 13 Triangular fixation = 2 Additional anterior fixation plate = 3 Navigation = 7	Time to surgery Mean (SD) 6.4 (4.1) Operation time Not reported Post op Regime Full weight-bearing plus 3 weeks community physio	Primary: two Years Secondary: 6 weeks, 3, 6 and 12 months included a clinical examination + radiographs
Hopf et al 35 Germany Retrospective case series	Posterior pelvic ring fractures. Over 55 years, low energy trauma. Persistent lower back pain or unacceptable mobility Exclusion Patients under 55 years with a high energy trauma. If pain improved within 6 days and mobility was acceptable	Screened ‘In the ‘recruitment period’ 87 patients with posterior ring fractures of the pelvis could be treated without surgery’ Sample size 30 Mean age (SD) Mean 78.4, range 56 to 96 Gender 27F:3M Comorbidities Osteoporosis=17	Concurrent Not reported Previous Not reported	Anterior + posterior = 18 Bilateral posterior = 11 Unilateral posterior = 1	Low energy = 30	IIliosacral screws per side One screw unilateral = 6 Two screws unilateral = 18 Three screws unilateral = 2 Bilateral one screw = 2 patients. Two screws one side, one screw on other side = 2	Time to surgery Mean 9.2 (range 1 to 24) Operation time Not reported Postop Regime Mobilised day 1 post op	Primary: mean 31 months Secondary: none

ASA, American Society of Anaesthesiologists physical status classification; ISS, injury severity score; SI, sacroiliac.