Twenty seven case-series (n=1,641, 28 groups or cohorts of patients) were included in the review. Most of the quality components in the studies were rated as fair or poor quality; the median quality score was 5 out of 12 (range 2 to 8).
Quality of reduction: For non-operative patients, quality of reduction was reported as excellent for 46%, good for 40% and poor for 38.5% (median figures). In the interior fixation of the anterior pelvis group equivalent figures reported were 43.5% excellent, 23% good and 19% poor. In the interior fixation of the posterior pelvis group the figures reported were 73% excellent, 19% good and 7% poor. Comparisons between internal fixation and non-operative treatment significantly favoured internal fixation for excellent reduction (p=0.06) and favoured posterior fixation over anterior fixation for excellent reduction (p=0.04).
Malunion: Median malunion rates were 30.3% (range 23% to 37.5%) for non-operative patients, 42% (range 9% to 64%) for anterior fixation and 7% (0 to 44%) for posterior fixation; internal fixation was significantly favoured over non-operative treatment (p=0.02).
Undisturbed gait: The median rate of undisturbed gait was significantly better (p=0.04) in patients who underwent internal fixation in comparison with the non-operative group; 68% in the non-operative group, 84% in the anterior fixation group and 84.5% in the posterior fixation group.
There were no statistically significant differences between the different treatments for infection, pin track infection, loss of reduction, implant failure, pain intensity and quality of life.