Percutaneous Fixation for Traumatic Symphysis Pubis Disruption-Are the Results Superior Compared to Open Techniques? A Systematic Review and Meta-Analysis of Clinical and Biomechanical Outcomes

Introduction: Open reduction and reconstruction plate and screws fixation (RPSF) is considered the gold standard for the treatment of traumatic symphysis pubis diastasis (SPD). Percutaneous cannulated screw fixation (PCSF) has recently gained popularity as it may reduce operative time and morbidity. The current systematic review aims to compare the clinical and radiological outcomes of PCSF and RPSF in traumatic SPD and analyze the biomechanical effectiveness of PCSF. Material and Methods: The Medline, Scopus, and Cochrane databases were searched until February 2023. The primary outcomes were the incidence of implant failure and revision surgery and the amount of displacement of symphysis pubis. Secondary outcomes were the intraoperative blood loss, the scar length, the operative time, the wound infection, and the patients' functional improvement. Results: Six clinical trial studies with a total of 184 patients and nine biomechanical studies were included. There was no significant difference between the two groups regarding the incidence of implant failure, the prevalence of revision surgery, and the amount of postoperative loss of reduction (p > 0.05 for all outcomes). The intraoperative blood loss (14.9 & PLUSMN; 4.2 mL for PCSF versus 162.7 & PLUSMN; 47.6 mL for PCSF, p < 0.001) and the incision length (1.7 & PLUSMN; 0.9 mL for PCSF versus 8 & PLUSMN; 1.4 mL for PCSF, p < 0.001) were significantly lower after PCSF. The mean operative time was 37 & PLUSMN; 19.1 min for PCSF and 68.9 & PLUSMN; 13.6 min for RPSF (p < 0.001). The infection rate was less frequent in the PCSF group (3% for PCSF versus 14.3% for RPSF, p = 0.01). One clinical trial reported better functional recovery after PCSF. In all biomechanical studies, the threshold for implant failure was beyond the applied forces corresponding to daily activities. Conclusions: PCSF for traumatic SPD is associated with less operative time, less blood loss, and a lower infection rate when compared to conventional plate techniques without increasing the incidence of postoperative fixation failure and revision surgery. Moreover, PCSF has been proven to be biomechanically sufficient for stabilization. Therefore, it should be considered an efficient and viable alternative for the reconstruction of SPD when closed reduction can be adequately achieved.

Automated summary

This study compares the clinical and radiological outcomes of percutaneous cannulated screw fixation (PCSF) and conventional plate fixation in the treatment of traumatic symphysis pubis diastasis (SPD), and analyzes the biomechanical effectiveness of PCSF. The results show that PCSF has advantages over conventional plate fixation in terms of operative time, intraoperative blood loss, and infection rate, without increasing the incidence of postoperative fixation failure and revision surgery. Biomechanical studies confirm the stability of PCSF. Therefore, PCSF should be considered as an effective and feasible alternative for the treatment of SPD when closed reduction is achievable.