Abstract
Purpose of study
Unstable pelvic ring injuries usually occur in polytrauma patients and are associated with high mortality and morbidity. Percutaneous screw fixation of sacro-iliac joint dislocations, fracture-dislocations and sacral fractures is a well-recognised technique first described by Routt and is increasingly gaining popularity. 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 results of patients treated with closed reduction and percutaneous ilio-sacral screw fixation for unstable pelvic ring fractures by a single surgeon.
Methods
A review of prospectively collected data was performed on all patients who had percutaneous sacro-iliac fixation between 2009 and 2012. Thirty five percutaneus sacro-iliac screws were inserted in 30 patients with a mean age of 25.6 years (range 17–62). Fracture types included 10 AO type B, and 20 AO type C. The mean follow-up period was 11.6 months (range 3–38).
The complications assessed were screw misplacement, neurovascular complications, hardware breakage and loss of reduction.
Results
All patients had a satisfactory initial reduction. One patient (2.8%) had misplacement of a screw with resultant temporary neurological fallout. One patient (2.8%) had screw misplacement without neurological fallout. Both of these patients initially had two screws inserted and the misplaced screws were removed and not reinserted. One patient (2.8%) had screw cut-out with loss of reduction. This screw was removed, open reduction peformed and the screw was re-inserted.
Conclusion
The use of percutaneous sacro-iliac screws provides a safe and effective technique for the management of unstable posterior pelvic ring injuries. Our combined complication rate is comparable to published literature.
NO DISCLOSURES
