LAUSR

We read with interest the recent article by Stewart et al., who concluded a systematic review and meta-analysis study that considered the external fixation of unstable pelvic fractures. In this study, it is indicated that the use of supra-acetabular pins over iliac crest pins may decrease re-displacement in unstable pelvic fractures. This study has some good points about unstable pelvic fractures, and so, we have some comments. First, about the adaptation of systematic review guidelines and registrations, there have been systematic review and meta-analysis protocol registration established to help maintain a level of homogeneity and quality across all meta-analyses and systematic reviews being conducted. PRISMA, Cochrane, JBI and MOOSE are a few examples of such guidelines. Second, this study did not consider the risk of bias of the study by standard tools. It is better to consider the inclusion of the ‘funnel plot’, ‘Orwin’s classic fail-safe N test’ and the ‘Duval and Tweedie’s trim and fill’ to present a better analysis of the possible publication bias as they are the standard tools used for assessment of bias. Third, the numbers of subjects and studies included were relatively low. There were only nine studies, which may not have enough persuasion to support the use of supra-acetabular pins over iliac crest pins. Finally, literature search is the most important step in any metaanalysis. Lack of inclusion of relevant studies might influence the overall findings of the meta-analysis. In the study by Stewart et al., the related words were not enough to reach relevant articles.