Twenty-five studies (n=437) met the inclusion criteria: 10 case series and 15 case reports. All the studies were classified as level IV evidence.
Malunion was recorded in 133 patients and nonunion in 193 patients. Overall, 341 (79%) of patients with pelvic girdle malunion and nonunion were treated initially either nonoperatively or just by external fixation systems. The combination of open reduction-internal fixation and bone grafting was the method most frequently used for treatment of pelvic malunion and nonunion, and reported in 288 patients (67%). The average operative time was 6.1 hours (six studies, n=106). Twenty-one studies (n=396) reported an average time of 26 months (10 weeks to 15 years) between initial injury and surgical treatment.
Treatment of complications associated with malunion and nonunion appeared effective in most cases: overall union rates averaged 86%; pain relief as much as 93%; patient satisfaction 79%; and return to a pre-injury level of activities 56%.
Incidence of perioperative complications was recorded: neurologic injury (5.3%); symptomatic vein thrombosis (5.0%); pulmonary embolism (1.9%); and deep wound infection (1.6%). The average amount of intraoperative blood loss was 1,193mL (range 12mL to 7,200mL). Implant loosening and breakage occurred in only 13 cases (3.1%). Twenty-five patients (6.0%) required one to three reoperations before a satisfactory final result was achieved. Intraoperative bladder injuries occurred in 0.8% of cases. Vascular injuries occurred in 0.5% of cases. Overall recovery rate of patients varied from very good (79%) to poor (15%).