The safety and efficacy of percutaneous sacroiliac joint screw fixation.
Keywords:unstable pelvic ring injuries, percutaneous sacroiliac fixation, pelvis fracture fixation
PURPOSE OF STUDY: Percutaneous screw fixation of sacroiliac joint dislocations, fracture-dislocations and sacral fractures is a well-recognised technique first described by Routt and has increasingly gained popularity in recent times. This method is biomechanically comparable to open reduction and internal fixation with plates and screws but offers the advantages of minimally invasive surgical techniques. It is however a technically demanding procedure with reported complications including hardware failure, misplacement of screws, nerve injury and poor posterior reduction. The purpose of the study is to report clinical and radiological results of patients treated with closed reduction and percutaneous iliosacral screw fixation for unstable pelvic ring fractures.
METHODS: A retrospective review of clinical notes and radiological studies was performed on all patients who had percutaneous sacroiliac fixation between 2009 and 2012. Forty-five percutaneous sacroiliac screws were inserted in 41 patients with a mean age of 25.6 years (range 17-62). Fracture types included 15 AO type B, and 26 AO type C.
RESULTS: All patients had a satisfactory initial reduction. One patient (2.4%) had screw misplacement with resultant temporary neurological fallout. One patient (2.4%) had screw misplacement without neurological fallout. Both these patients initially had two screws inserted and the misplaced screws were removed and not resited. One patient (2.4%) had screw cut-out with loss of reduction. This screw was removed, open reduction performed, and the screw was reinserted.
CONCLUSION: The use of percutaneous sacroiliac screws provides a safe and effective technique for the management of unstable posterior pelvic ring injuries. Our combined complication rate compares favourably with published literature.