J Korean Orthop Assoc.  2009 Feb;44(1):1-7. 10.4055/jkoa.2009.44.1.1.

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

• Kim WY
• Ji JH
• Kwon OS
• Park SE
• Kim YY
• Moon CY

• KMID: 2186371
• DOI: http://doi.org/10.4055/jkoa.2009.44.1.1

Abstract

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.

Keyword

Unstable pelvis fracture; Percutaneous iliosacral screw fixation; Number and position of screws

MeSH Terms

Displacement (Psychology)
Follow-Up Studies
Hand
Humans
Pelvis

Figure

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  Fig. 1 (A) A 39 year-old male patient who has unstable pelvic fracture with sacral fracture including left superior and inferior rami and sacroiliac joint disruption. (B) External fixator and percutaneous SI screws fixation on S1 and S2 were performed. (C) Last follow up X-ray shows stable union.

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  Fig. 2 (A-C) A 59 year-old male patient who has unstable pelvic fracture with right acetabular fracture, left ramus fracture, sacral fracture and sacroiliac joint disruption. (D) Plate fixation on acetabular fracture, cannulated screw on left ramus fracture and percutaneous IS screw fixation on S1 due to narrow safe zone. (E) Follow up x-ray shows displacement of IS screw and patient complained buttock pain. (F) Second operation as Lt SI joint fusion with plate and screws fixation was performed.

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  Fig. 3 (A, B) A 39 year-old male patient who has Tile type C unstable pelvic fracture which were right side fracture of S2, sacroiliac joint disruption and symphysis pubis diastasis on x-ray and 3D CT. (C, D) Percutaneous IS screws fixation on S1 and S2 including interfragmentary screw fixation about S2 fracture under C-arm guidance. (E) Postoperative X-ray shows stable fixation with well reduction of the unstable pelvis.

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