Abstract
BACKGROUND: Pelvic ring injuries are common in multi-trauma patients and can be life-threatening, necessitating prompt surgical intervention to improve outcomes. However, surgery can lead to complications such as iatrogenic nerve injury. This network meta-analysis aimed to improve outcomes in multi-trauma patients with pelvic ring injuries by evaluating the incidence of iatrogenic nerve injuries, identifying vulnerable nerves, and comparing different fixation methods. MATERIALS AND METHODS: A systematic search of MEDLINE, EMBASE, and Scopus from inception to 5 December 2023 revealed 29 comparative studies on the incidence of iatrogenic nerve injury in 1561 adult patients with pelvic ring injuries. Data were extracted on study and patient characteristics, iatrogenic nerve injury incidences, and specific nerve injuries. A random-effects model assessed treatment effects, with subgroup analysis and meta-regression. The main outcomes included odds ratios (ORs) and confidence intervals (CIs) for iatrogenic nerve injuries. RESULTS: Compared with closed reduction internal fixation, robotic-assisted techniques had the highest, and open reduction internal fixation had the lowest ORs for iatrogenic nerve injuries. The robotic-assisted approach ranked best with an OR of 0.22 (95% CI: 0.02-2.16), while closed reduction internal fixation with the anterior approach (OR: 0.71; 95% CI: 0.21-2.48) and open reduction internal fixation with the anterior approach performed the worst. The lateral femoral cutaneous nerve was injured in all open reduction internal fixation with anterior approach procedures and in 66.7% of open reduction internal fixation with posterior approach procedures. Meta-regression showed a significantly lower OR for iatrogenic nerve injuries in patients aged >41.4 years in the open reduction internal fixation with the anterior approach group (OR: 0.02; 95% CI: 0.001-0.63; P = 0.026) compared with younger patients. CONCLUSION: The robotic-assisted technique may result in the fewest iatrogenic nerve injuries during the treatment of pelvic ring injuries. The posterior approach may also reduce the risk of iatrogenic nerve injuries.