Table 2 Mastersheet Literature Review on Functional Outcome in Lumbopelvic Fixation.

Schildhauer et al. (2006)/J Orthop Trauma⁵

LPF

To report results of sacral decompression and lumbopelvic fixation in neurologically impaired patients with highly displaced, comminuted sacral fracture-dislocations resulting in spino-pelvic dissociation

rca

n = 19

11m/8f

Highly displaced comminuted, irreducible Roy-Camille type 2-4 sacral fractures with spinopelvic instability and cauda equina deficits

n/a

Bellabarba et al. (2006)/Spine⁶

LPF

To review the safety and patient impact of early surgical decompression, and rigid segmental stabilization in patients with high-grade sacral fracture dislocations

rca

n = 19 (11m/8f)

11m/8f

19 patients with Denis zone 3 injuries. Six presented with Roy-Camille type 3 injuries, 4 with type 4 injuries, and 9 with type 2 injuries. Two fractures were open secondary to extensile perianal soft tissue lacerations. There were 10 other patients who were considered to have clinically relevant soft tissue contusions with lumbodorsal fascial degloving analogous to the Morel Lavalle lesion

3 pat. with postop. infections ISS > 20 versus non-infection ISS 14

Lindahl (2008)/Suomen Ortopedia ja Traumatologia^a25

LPF

To describe the functional outcome in patients with spinopelvic dissociation

rca

n = 19

8m/11f

Patients with spinopelvic dissociation and type 2–3 Roy-Camille + Strange-Vognsen/Lebech fractures; bilateral vertical sacral fractures with spinopelvic instability and cauda equina deficits and/or lumbosacral plexus injury

40 (18–66)

Lindahl (2009)/Suomen Ortopedia ja Traumatologia ^a26

LPF

To evaluate the results of operative reduction and lumbopelvic fixation of patients with high-energy sacral fracture dislocations with spino-pelvic dissociation and neurologic deficits

pca

n = 22

10m/12f

Patients with Roy-Camille type 2 or type 3 comminuted bilateral vertical and horizontal sacral fractures with spinopelvic instability and cauda equina deficits and/or lumbosacral plexus injury, were treated with segmental lumbopelvic fixation

41 (18–66)

Gribnau et al. (2009)/Injury¹³

Different methods of posterior stabili-zation

This study intended to assess the injury characteristics, choice of treatment and quality of life of U-shaped sacral fractures

rca

n = 8

3m/5f

Patients with a high-grade U-shaped sacral fracture (Denis Zone III) were included in the study. All patients suffered high-energy trauma. Mechanism of injury included suicidal leaps (n = 7) and accidental falls from heights (n = 1). The fall height ranged from 10 to 20 m.The method of fixation was individualised and consisted of either open posterior transsacral plate fixation, percutaneous sacroiliac screw fixation or open triangular lumbosacral fixation

23 (17–45)

Sagi et al. (2009)/J Orthop Trauma⁷

LPF

To analyze the radiographic, clinical, and functional results of triangular osteosynthesis constructs for the treatment of vertically unstable comminuted transforaminal sacral fractures

pca

n = 40

n/a

Patients with vertically unstable pelvic injuries were treated with triangular osteosynthesis fixation

n/a

Jones et al. (2012)/Clin Orthop Relat Res¹⁰

LPF

To assess the reduction quality and loss of fixation, pain related to prominent hardware, subjective dysfunction measured by the Short Musculoskeletal Function Assessment (SMFA), and complications

rca

n = 15

7m/8f

Patients with unstable sacral fractures treated with lumbopelvic fixation

4/15 patients had an ISS > 15 and were classified as polytrauma

Tan et al. (2012)/Injury²⁷

LPF

To report the outcome of patients who underwent lumbopelvic fixation for spinopelvic instability

rca

n = 9

6m/3f

Patients with spinopelvic instability and cauda equina deficits; the vertical fractures totally involved zone II of the sacrum, and most were comminuted

n/a

Ayoub (2012)/Eur Spine J¹⁸

LPF

To evaluate and analyze the results of surgical decompression and lumbopelvic fixation of these injuries

rca

n = 28

17m/11f

Patients with displaced spinopelvic dissociation and cauda equina syndrome

Roy-Camille classification:

Type 2: 13

Type 3: 15;

Cauda equina syndrome:

incomplete: 17

complete: 11;

Unilateral L5–S1 facet joint injury: 13;

Direct decompression: 14

Indirect decompression: 14

n/a

Hu et al. (2013)/Eur Spine J²⁸

LPF

The aim of this study was to explore the operative technique and effectiveness of triangular osteosynthesis for vertically unstable sacral fractures

pca

n = 25

12m/9f

13 mva, 6fall from height;

16 cases of unilateral vertical unstable sacrum fractures were fixed with unilateral triangular osteosynthesis;

3 patients with bilateral sacrum fractures were fixed with bilateral triangular osteosynthesis;

3 bilateral fractures were fixed with unilateral triangular osteosynthesis as one side of the sacrum fracture was stable;

5 patients were performed sacral laminectomy for cauda equina decompression;

8 patients who suffered sacral plexus impairment were decompressed through fracture reduction or their small fractures were removed

n/a

Dalbayrak et al. (2013)/Turk Neurosurg²⁹

LPF

To describe the outcome of standard lumboiliac instrumentation in patients with spinopelvic instabilities

rca

n = 10

6m/4f

Denis type 1: 4

Denis type 2: 3

Denos type 3: 2

unilateral sacroiliac instability: 6 bilateral sacroiliac instability: 4

n/a

He et al. (2014)/Orthopedics³⁰

LPF

To report the authors’ experience with treating patients with type III Denis sacral fracture with lumbopelvic dissociation

rca

n = 21

13m/8f

Fall: 13

traffic trauma: 6

crush-related injury: 2

involved multiple injuries:11;

Roy-Camille classification:

Type 2: 9

Type 3: 12

n/a

Lindahl et al. (2014)/Injury¹⁹

LPF

The aim of this retrospective study was to evaluate the radiological and clinical outcomes including neurological recovery after segmental lumbopelvic fixation of spinopelvic dissociation, as well as to uncover prognostic factors of outcome

rca

n = 36

18m/18f

fall from a height: 27

mva: 6

crush injury: 3

median fall height was 10 m (range, 2–20 m);

12 patients had concomitant fractures; All 36 patients had AO type C3 pelvic injuries and Denis zone III H-shaped sacral fractures.

Roy-Camille classification:

Type 2: 15

Type 3: 21

16 patients had complete translational displacement in the transverse sacral fracture in either ventral or dorsal direction

27 (16–54)

Williams et al. (2016)/J Orthop Trauma³¹

Percu-taneous LPF

To describe a percutaneous lumbopelvic reduction and fixation technique to reduce complications

pca

n = 17

n/a

Bilateral longitudinal and transverse sacral fracture patterns (U/H-tpye)

n/a

Schildhauer et al. (2006)/J Orthop Trauma ⁵

Average 31 mo

(12–57)

n/a

n/a

n/a

n/a

n/a

n/a

Bellabarba et al. (2006)/Spine⁶

Average 25 mo

(7–37)

n/a

n/a

n/a

n/a

n/a

Average VAS 5.5

Lindahl (2008)/Suomen Ortopedia ja Traumatologia ^a25

n/a

n/a

n/a

n/a

n/a

Mean Hannover score: 5,3 (3–7) postoperatively

n/a

Lindahl (2009)/Suomen Ortopedia ja Traumatologia ^a26

n/a

n/a

n/a

n/a

n/a

n/a

n/a

Gribnau et al. (2009)/Injury¹³

36 mo (5–36)

n/a

n/a

Median EQ-6D VAS score was 70 (range, 50–80)

n/a

n/a

n/a

Sagi et al. (2009)/J Orthop Trauma⁷

18 mo (12–23)

Function and daily activity showed significant improvements; function index improved from an average of 26 at 6 mo to 21 at 1 year (p = 0.07); bother index improved from 29 at 6 months to 24 at 1 year (p = 0.17); daily activity index improved from 33 to 23 (p = 0.01); mobility improved from 33 at 6 months to 29 at 1 year (p = 0.17)

SF-36v.2 physical component scores averaged 42 (range 26.6–62.8) at 6 months and 46 (range 31.6–63) at 1 year

n/a

n/a

n/a

n/a

Jones et al. (2012)/Clin Orthop Relat Res¹⁰

23 mo

(12–41)

11/15 patients were able to return to work or activities. 4/15 patients had palpable prominent posterior hardware. 4 patients had associated lower extremity injuries, which did not affect daily activity, mobility, dysfunction, or bother at any time

n/a

n/a

n/a

n/a

Greater pain at 1 year in patients with prominent hardware (3.5 out of 5) compared with patients without prominent hardware (1.75 out of 5)

Tan et al. (2012)/Injury

²⁷

21.7 mo

(14–32)

n/a

n/a

n/a

n/a

n/a

n/a

Ayoub (2012)/Eur Spine J¹⁸

26 mo

n/a

n/a

n/a

n/a

Excellent: 5

Good:14

Fair: 7

Poor: 2

n/a

Hu et al. (2013)/Eur Spine J²⁸

14 mo (8–26)

n/a

n/a

n/a

n/a

n/a

n/a

Dalbayrak et al. (2013)/Turk Neurosurg ²⁹

39.2 mo (6–91)

n/a

n/a

n/a

Preoperative ODI: 91.2; postoperative ODI: 24.4

n/a

Preoperative VAS: 8.4; postoperative VAS: 2.2

He et al. (2014)/Orthopedics ³⁰

20 mo (8–36)

n/a

n/a

n/a

n/a

n/a

n/a

Lindahl et al. (2014)/Injury¹⁹

33 mo (18–71)

n/a

n/a

n/a

n/a

n/a

n/a

Williams et al. (2016)/J Orthop Trauma ³¹

21 mo

n/a

n/a

n/a

n/a

n/a

De lure (2016)/Injury³²

LPF +trans-verse bar

To analyze short- and long-term complications and final clinical outcome in this series

rca

n = 11

6m/5f

11 patients with severe posttraumatic lumbopelvic instability following a high-energy trauma

33.7 (17–50)

Yu et al. (2016)/Injury³³

LPF

To report the peri-operative results and surgical outcomes of patients with vertical unstable sacral fractures who underwent lumbopelvic fixation through a modified subcutaneous route for iliac screw fixation

rca

n = 28

8m/19f

28 consecutive patients with vertical unstable sacral fractures

Fall from height: 15

Motor vehicle collision: 12

Blunt trauma: 1

Roy-Camille Classification:

Type 1: 6

Type 2: 9

Type 3: 1

Type 4: 3

19.5 (9–50)

Piltz et al. (2017)/Eur Spine J³⁴

mod. LPF

Purpose of this study is to present a surgical technique that facilitates the reduction and the stabilization of these injuries

rca

n = 3

3f

Fall, suicidal fall, mva;

Roy-Camille classification: 2,4,1; neurological deficit: sensory deficit root S1&S2, none, sensory deficit root S1 right side

n/a

Jazini et al. (2017)/The Spine Journal³⁵

MIS LPF

The study aimed to determine whether minimally invasive LPF provides reliable frac- ture stability and acceptable complication rates in cases of complex sacral fractures

rca

n = 24

12m/12f

“24 patients who underwent MISLPF for complex sacral fracture with or without associated pelvic ring injury; mva: 11

Falls: 6

sacral fracture morphologies: vertical (Zone I, 4 of 24 injuries; Zone II, 7 of 24; Zone III, 2 of 24), transverse (12.5%; Zone III, 3 of 24) H-type (16.7%; Zone III, 4 of 24)

T-type (8.3%; Zone III, 2 of 24)

U-type (4.2%; Zone III, 1 of 24) lambda-type (4.2%; Zone III, 1 of 24)

Out of the Denis Zone III injuries (n = 13) five were Roy-Camille type 1, four were type 2, three were type 3, and one was type 4.

bilateral LPF (22 of 24 constructs) with instrumentation from L5 to the ilium (17 of 24 constructs)

27 (5–48)

Xie et al. (2018)/Current Medical Science¹⁴

LPF

To examine the use of lumbopelvic fixation or (and) sacral decompression to treat U-shaped sacral fractures and the quality of life of patients after treatment in an attempt to provide evidence of effects of such treatments on functional and neurological recovery of patients with U-shaped sacral fractures

rca

n = 15

9m/6f

Consecutive patients with U-shaped sacral fractures; all high energy traumas; most patients underwent LPF and sacral decompression

28.2 (20–43)

Nonne et al. (2018)/J Med Case Rep³⁶

LPF + trans-verse bar

To report 5 cases of patients with spinopelvic dissociation

rca

n = 5

2m/3f

Five patients with spinopelvic dissociation. All patients showed severe neurologic lesions:

cauda equina syndrome (n  =  3) and bilateral radicular L5–S1 deficit (n  =  4). Roy-Camille II n = 2; III n = 2; IV: n = 1. One patient died

n/a

Tian et al. (2018)/Orthopaedic Surgery³⁷

mod. LPF

To evaluate the clinical outcomes of traumatic spino‐pelvic dissociation (TSD) treated with modified bilateral triangular fixation

rca

n = 18

14m/4f

Falling: 16

mva: 2

all sacral fractures had associated injuries

U‐shaped fractures: 10

H‐shaped fractures: 6

Y‐shaped fractures: 2

Roy–Camille classification:

type II: 12

type III: 6

sacral plexus decompression: 6 cases

n/a

Futamura et al. (2018)/

International Orthoaedics ³⁸

mod. LPF

To describe the procedure and outcomes of a new approach, which we refer to as “within ring”-based sacroiliac rod fixation (SIRF)

rca

n = 15

10m/5f

Fall:7

mva: 5

Compression by a heavy item:3

AO/OTA class:

61-B2.3: 1

C1.3: 4

C2.3: 7

C3.3: 1

H-type spinopelvic dissociation: 2

16.9 (9–30)

Chou et al. (2018)/Journal of the American Academy of Orthopaedic Surgeons ³⁹

MIS-LPF

To present a series of spinopelvic dissociation cases from a level I trauma center

rca

n = 18

n/a

None of the patients underwent open spinal surgical decompression

n/a

Abo-Elsoud et al. (2018)/Journal of Orhtopaedic Trauma⁴⁰

mod.LPF

To preset a modified biplanar posterior pelvic fixation technique in patients with unstable sacral fractures

rca

n = 16

9m/7f

Patients with unilateral vertical sacral fractures showing fracture comminution, gaps, vertical instability, and/or disruption of the L5/S1 facet joint

n/a

Shah et al. (2019)/Cureus⁴¹

MIS-LPF

To analyze the outcome and complications of patients who underwent minimally invasive lumbopelvic fixation to treat unstable U-type sacral fractures

rca

n = 10

n/a

Adult patients with U-type or vertical shear fractures

n/a

Santoro et al. (2019)/World Neurosurgery ⁴²

Navigated Spino-pelvic and Sacro-pelvic Stabili-zation

To analyze the difficulties and advantages for surgeons by using digital navigation based on preoperative computed tomography

rca

n = 25

21m/4f

Adults patients with pelvic fractures (Tile classification):

B1 n = 5; B2 n = 2; B3 n = 2;

C1 n = 9; C2 n = 3; C3 n = 4

n/a

Korovessis et al. (2019)/European Spine Journal⁴³

LPF

To evaluate the efficacy and safety of contemporary spinal instrumentation for AO C-type posterior pelvic ring injuries

rca

n = 6

4m/2f

Patients with AO C-type posterior pelvic ring injuries:

C1 n = 1; C2 n = 2; C3 n = 3

n/a

Kanezaki et al. (2019)/Medicine⁴⁴

Minimal invasive LPF

To describe the minimal invasive technique and report the preliminary clinical results

rca

n = 10

6m/3f

Denis Zone 1 n = 2

Denis Zone 2 n = 2

Denis Zone 3 n = 6

Roy-Camille classification

type 1 n = 4

type 2 n = 2

n/a

Kelly et al. (2018)/Journal Spine Surgery

²⁴

LPF

To compare surgical outcomes of U and H type sacral fractures with surgical management by lpf (or iliosacral screw fixation)

rca

n = 8

n/a

Roy-Camille classification (mean): 2.1

Seven out of eight patients underwent sacral decompression

n/a

De lure (2016)/Injury³²

7.2 y (4–13.2 y)

n/a

n/a

n/a

2 patients with minimal disability, four with moderate disability, three with severe disability, and none crippled or above 80% of the index

n/a

Light-to-moderate lower back pain: 6 night-time pain: 2 at final follow-up one patient reported only light pain following intense physical activity

Yu et al. (2016)/Injury³³

12 mo

n/a

n/a

n/a

n/a

n/a

n/a

Piltz et al. (2017)/Eur Spine J³⁴

47, 33, 29 mo

n/a

n/a

n/a

n/a

n/a

n/a

Jazini et al. (2017)/The Spine Journal³⁵

18.8 mo (0.4–64)

n/a

n/a

n/a

n/a

n/a

n/a

Xie et al. (2018)/Current Medical Science¹⁴

22.7 mo (9–47)

n/a

n/a

EQ-5D preop: mean 0.203 (0.144–0.279) versus EQ-5D postop mean 0.786 (0.636–0.,819)

n/a

n/a

All patients reported pain: average preop VAS score of 7.07 (5–9) postoperative VAS score of 1.93 ( 1–3) (p < 0.0001)

Nonne et al. (2018)/J Med Case Rep³⁶

20 mo

(12–36)

n/a

n/a

n/a

n/a

n/a

n/a

Tian et al. (2018)/Orthopaedic Surgery³⁷

32.4 mo (22–48)

n/a

n/a

n/a

n/a

n/a

n/a

Futamura et al. (2018)/International Orthoaedics³⁸

23.8 mo (4–50)

n/a

n/a

n/a

n/a

n/a

n/a

Chou et al. (2018)/Journal of the American Academy of Orthopaedic Surgeons ³⁹

18mo (12–68)

n/a

n/a

EQ-5D-5L: 6 patients unable to contact, two remained homeless with no contact details, one patient was sectioned in a mental health unit, 3 were lost to follow-up

2 retired from work because of age,2 remained homeless and unemployed

5 have returned to full work

n/a

n/a

n/a

Abo-Elsoud et al. (2018)/Journal of Orhtopaedic Trauma⁴⁰

29.5mo (14–43)

n/a

n/a

n/a

n/a

n/a

3 Patients requested implant removal because of implant prominence (1 patient) or lower lumbar pain (2 patients)

Shah et al. (2019)/Cureus⁴¹

2–3 months

n/a

n/a

n/a

n/a

n/a

VAS 1.7 at follow-up

Santoro et al. (2019)/World Neurosurgery ⁴²

Mean fu 12 months

n/a

n/a

n/a

n/a

n/a

n/a

Korovessis et al. (2019)/European Spine Journal⁴³

61 ± 8 months

n/a

n/a

n/a

n/a

n/a

n/a

Kanezaki et al. (2019)/Medicine⁴⁴

15.0 ± 8.5 months

n/a

n/a

n/a

n/a

n/a

n/a

Kelly et al. (2018)/Journal Spine Surgery²⁴

18 mo (1–52)

n/a

n/a

n/a

n/a

n/a

n/a