Unstable pelvic ring fracture: percutaneous sacroiliac fixation

Purpose of the study We report our experience with percutaneous sacroiliac screwing for unstable pelvic ring fracture. Material and methods Twenty unstable pelvic ring fractures with sacroiliac disjunction (9 cases), trans-sacral fracture (9 cases), or bilateral posterior fractures (5 cases) were managed with percutaneous sacroiliac fixation using 1 or 2 screws. There was also pubic disjunction in 7 cases, managed by osteosynthesis in 5 cases. No fixation of fractures of one or both of the obturator rings, present in 13 cases, was attempted. The posterior screwing was performed under fluoroscopic guidance in 15 cases and computed tomographic guidance in 5. Results There were no infectious or neurological complications. Radiographically, anatomic reduction of the posterior fracture was achieved in 10 cases. A vertical ascension persisted in 4 patients and a rotation in 6. Radiographic results were correlated with delay to surgery: correction of the vertical displacement was achieved in 80 % of the patients operated before five days and in 55 % of the others. Two patients experienced a secondary displacement. There was no cases of nonunion of either the anterior or posterior fracture. Follow-up was available for 14 patients (2 patients died and follow-up was too short for 4). The mean Majeed score was 92/100 and none of the patients experienced anterior pain. Three patients had moderate pain in the sacroiliac area. Discussion The ventral position appears to be best adapted for percutaneous sacroiliac screwing but can be contraindicated by concomitant lesions. We prefer fluoroscopic guidance for these emergency procedures. Two views, ascending and descending, appear sufficient. The better stability provided by two screws can be achieved under computed tomographic guidance without risk of neurovascular damage. Conclusion Percutaneous sacroiliac screwing is a good management strategy for unstable pelvic ring fractures with little risk of morbidity.