Results of open reduction internal fixation versus percutaneous iliosacral screw fixation for unstable pelvic ring injuries: retrospective study of 36 patients.

INTRODUCTION: Surgical stabilization of posterior pelvic ring fractures can be achieved by closed reduction and percutaneous fixation (CRPF) or by open reduction and internal fixation (ORIF). The aim of the present study is to compare the clinical results of both methods. MATERIAL AND METHODS: Medical records of 36 patients consecutively operated for unstable pelvic ring injuries were retrospectively reviewed. We compared 22 patients treated with CRPF versus 14 patients stabilized by using ORIF between 2007 and 2017. The Majeed and Pohlemann scores were used to evaluate postoperative functional outcomes. Complications like blood loss, infection rate, Neurological injury, the operative time and the length of hospital stay were analyzed. RESULTS: The median Majeed pelvic score was 87 points for the CRPF technique compared with 69 points for the ORIF technique. The median Pohlemann score, operative time and length of hospitalization were similar between the two groups. The median blood loss for the CRPF technique was 300 ml compared to 500 ml for the ORIF technique. CRPF and ORIF procedure had each one neurological lesion. There was one case of infection in the ORIF group and none in the CRPF group. No measurements except for the blood loss have reached the significance threshold. CONCLUSION: The CRPF technique shows a clear decrease in blood loss. There was no statistically significant difference in the functional results, infection rate, neurological injury, operative time and hospital stay between both techniques.

Spino-Pelvic Fixation in Unstable Sacral Fracture: A Case Report

A 22-year-old female patient visited the emergency room (ER) after a pedestrian traffic accident in a drunken state. An examination at the ER revealed fractures at the right side of the sacral ala, sacral foramina, left anterior acetabulum, right inferior ramus, and right superior articular process of S1. She underwent spino-pelvic fixation and iliosacral (IS) screw fixation. One year later, bone union was completed and implant removal was performed and the treatment was completed without complications. The authors recommend spino-pelvic fixation and IS screw fixation for unstable sacral fractures as one of the excellent methods for obtaining posterior stability of the pelvis among the various treatments of unstable sacral fractures.

Percutaneous Ilio-sacral Screw Fixation for Unstable Pelvic Ring Injuries.

This prospective interventional study was planned to determine the clinical and radiological outcome of percutaneous iliosacral screw fixation for unstable pelvic ring injuries. It was conducted from March 2008 to June 2014 at the Department of Orthopaedic Surgery Combined Military Hospital (CMH) at Lahore, Multan, Rawalpindi and Muzaffarabad. It comprised 50 patients with unstable pelvic ring injuries. Visual analogue scale (VAS), Majeed pelvic score and Lindahl criteria were used for functional and radiological outcomes assessment. The mean age of the patients was 47.82±8.94 years. Moreover, 33(66%) participants were males and 17(34%) were females. The mean pre-operative Majeed and VAS scores were 38.98±6.28 and 9.04±0.67, respectively. Operating time and blood loss were reduced significantly. VAS score for post-operative pain was 3.82±1.26 at 1 month and decreased further to 2.68±1.30 at 12 months post-operatively (p<0.001). Radiological outcome and the post-operative Majeed scores were good to excellent in 43(86%) cases. Thus Percutaneous iliosacral screw fixation of unstable pelvic ring injuries resulted in excellent radiological and functional outcome with significantly decreased post-operative VAS score for SI joint pain.

Percutaneous iliosacral screw fixation after osteoporotic posterior ring fractures of the pelvis reduces pain significantly in elderly patients.

INTRODUCTION: Osteoporotic posterior ring fractures of the pelvis are common injuries in the elderly, but the treatment of these fractures still remains controversial. Percutaneous iliosacral screw fixation is one surgical option if conservative treatment cannot provide sufficient pain reduction. The aim of this study is to provide short-term results of elderly patients with percutaneous screw fixation. METHODS: 30 patients with posterior ring fractures were treated between 12/2009 and 01/2014 with percutaneous iliosacral screw fixation. Patients' mean age was 78.4 years. Concerning short-term outcome, we focused on initial pain level and postoperative pain reduction together with intra- and postoperative complications. RESULTS: The average hospital stay was 23.7 days, with surgical treatment performed after an average of 9.2 days. 90% of our patients were female. All 30 patients had a lower level of pain at discharge compared with admission or immediately prior to surgery. The difference in pain level at admission compared with the pain level upon discharge showed a mean reduction from 6.8 to 1.8 with a statistically significant change (P≤0.001). 24 of 30 patients had no registered complications, one screw malpositioning with postoperative nerve irritation occurred. DISCUSSION: Conventional percutaneous iliosacral screw fixation is a successful operative treatment for elderly patients with persistent lower back pain after unstable posterior ring fractures of the pelvis. Intra- and postoperative complications are rare, so this treatment can be regarded as a safe procedure. LEVEL OF EVIDENCE: IV (retrospective study).

Superior Gluteal Artery Injury during Percutaneous Iliosacral Screw Fixation: A Case Report.

Percutaneous iliosacral screw fixation is commonly practiced to treat unstable posterior pelvic ring injuries. The number of reported cases of iatrogenic complications is increasing. We present a case of superior gluteal artery injury during bilateral percutaneous iliosacral screw fixation in a patient with sacral fracture of spino-pelvic dissociation. This complication was managed by arterial embolization. We discussed the cause, prevention and treatment of arterial injury along with a review of literature.

Superior Gluteal Artery Injury during Percutaneous Iliosacral Screw Fixation: A Case Report / 대한고관절학회지

Percutaneous iliosacral screw fixation is commonly practiced to treat unstable posterior pelvic ring injuries. The number of reported cases of iatrogenic complications is increasing. We present a case of superior gluteal artery injury during bilateral percutaneous iliosacral screw fixation in a patient with sacral fracture of spino-pelvic dissociation. This complication was managed by arterial embolization. We discussed the cause, prevention and treatment of arterial injury along with a review of literature.

Treatment of Unstable Sacral Fractures Related to Spino-Pelvic Dissociations

PURPOSE: To evaluate the outcomes of surgical treatment modality in unstable sacral fractures combined with spinal and pelvic ring injury depending on the presence of spino-pelvic dissociations. MATERIALS AND METHODS: The subjects were 16 patients, with unstable sacral fractures combined with spinal and pelvic ring injuries, were operated from July 2004 to January 2011. The patients were divided into 2 groups depending on the presence of spino-pelvic dissociations: those with dissociations were group 1, and those without dissociations were group 2. Group 1 was treated with spino-pelvic fixations using iliac screw, while group 2 was treated with percutaneous iliosacral screw fixations. The availability of the radiological bony union with its application periods, and clinical results using visual analogue scale (VAS) and oswestry disability index (ODI) were evaluated, retrospectively. RESULTS: Out of 16 patients, 8 patients in group 1 were treated with spino-pelvic fixation using iliac screw, and 8 patients in group 2 were treated with percutaneous iliosacral screw fixation. The mean bony union period was 17.4 weeks in group 1, and 19.6 weeks in group 2. The Mean VAS and ODI scores on the last follow-up were 2.5 points and 15.6 points in group 1, 2 points and 18.8 points in group 2, respectively. Both groups had favorable clinical results at the last follow-up. CONCLUSION: For surgical treatments of unstable sacral fractures, spino-pelvic fixation using iliac screws is advised for cases with combined spino-pelvic dissociation, while percutaneous iliosacral screw fixation is advised for cases without combined dissociation.

Comparison with Number and Position of Percutaneous Iliosacral Screws as Treatment of Unstable Pelvic Fracture / 대한정형외과학회잡지

PURPOSE: A closed reduction of the posterior arch and percutaneous fixation with S1 and S2 iliosacral (IS) screw was performed on an unstable pelvis fracture with a disruption of the sacroiliac complex. The radiological and clinical results were analyzed according the number of screws and their position. MATERIALS AND METHODS: Of 31 cases with an unstable pelvis fracture involving the sacral complex, classified as Tile type C (AO/OTA), 16 and 15 cases were treated with one S1 screw fixation and two screws fixation into S1 and S2, respectively, using a percutaneous fixation technique. The patients were followed up for a minimum of 12 months and the radiological and clinical outcomes were analyzed statistically using the Majeed score and SF-36. RESULTS: Five cases of screw displacement occurred in the one screw fixation group. On the other hand, there was no screw displacement in the two screws fixation group after a mean follow-up of 40.2 months. In the case of a narrow safe zone (iliac cortical density, ICD), it is impossible to fix with two S1 screws. However, in these patients, good clinical results were achieved with S1 and S2 were achieved with S1 and S2 screw without complications. CONCLUSION: The technique of two screws fixation is an efficient and reliable method for reducing and fixing the unstable pelvic ring disruptions. Additional S2 screw fixation is recommended for patients with a narrow ICD.

Percutaneous Iliosacral Screw Fixation in Unstable Pelvic Ring Injury / 대한정형외과학회잡지

PURPOSE: To evaluate and analyse the operative results of percutaneous iliosacral screw fixation in displaced posterior pelvic ring injuries. MATERIALS AND METHODS: Fourteen consecutive patients with displaced posterior pelvic ring injuries (August 1995-June 1998) treated by percutaneous iliosacral screw fixation were reviewed. We analysed the pattern of fracture, associated injury and method of operation including patient's position, complication and functional result. RESULTS: Seventeen iliosacral screws under fluoroscopic guidance were applied in fourteen patients. During the operations various positions of patients were possible, and all cases were treated with closed reduction and percutaneous iliosacral screw fixation except in one case (open reduction and percutaneous screw fixation). Fixation of associated anterior pelvic ring injury was undertakes in eight cases. Screw-related neurovascular injury and other complications such as breakage, loosening, misplacement and redisplacement, nonunion and screw site infection during follow-up period were not found. Satisfactory clinical and radiologic results were achieved during follow-up period except in one case (limping due to leg length discrepancy, malreduction) in this study. CONCLUSION: Precise understanding of iliosacral anatomy and its variants, proper patient positioning and appropriate intraoperative interpretation of fluoroscopic iliosacral image are mandatory. We believe percutaneous iliosacral screw fixation is a useful addition to treatment options for unstable posterior pelvic ring injury.

Early Results of Percutaneous Ilioscral Screw Fixation in Unstable Posterior Pelvic Ring Injury / 대한정형외과학회잡지

In the past two decades, open reduction and internal fixation has been the preferred treatment of posterior pelvic ring disruption with instability. Despite of rigid fixation, it can induce bleeding, wound infection, wound necrosis and prolong operation time in the patient with combined injuries. To compensate for these disadvantages, we have implemented closed reduction and percutaneous iliosacral fixation under fluoroscopy in reducible posterior pelvic ring disruption. In spite of anatomical risk during screw insertion, the percutaneous iliosacral screw technique after closed reduction of the posterior pelvic ring disruption minimally violates the soft tissue envelope and reduces both the operative blood loss and infection rate. We are reporting the early results of our 6 patients treated between Aug. 1995 to Aug. 1996. The operation time was shorter than open reduction and internal fixation. There was no significant bleeding, wound infection and nerve injury by screws.