Posterior Iliac Crescent Fracture-dislocation: Is It Only Rotationally Unstable?

Abstract

Posterior iliac crescent fracture-dislocation is generally considered rotationally unstable and vertically stable. The current study (1) investigated whether vertical instability may occur in posterior iliac crescent fracture-dislocation and (2) analyzed the clinical features of vertically unstable iliac crescent fracture-dislocation as well as treatment strategies. Patients with pelvic fracture who were treated in the authors' department from June 2009 to June 2012 were retrospectively reviewed. This study analyzed the clinical features, including incidence, hemodynamic state, associated injuries, injury severity score, and treatment methods for vertically unstable iliac crescent fracture-dislocation. Four patients had vertically unstable fracture-dislocation, accounting for 12.9% of all iliac crescent fracture-dislocations. All 4 patients were hemodynamically unstable on admission and had complications of associated injuries with a higher injury severity score. In 3 of the 4 patients, iliac crescent fracture-dislocations were reduced via the posterior approach at the initial stage and these patients underwent fixation with a plate. The remaining patient was initially given transcondylar traction because of severe complications and underwent open reduction and internal fixation (ORIF) via a posterior approach at a later stage. The outcomes of all 4 patients were rated as good or excellent by the Kobbe rating system at the last follow-up. Vertical instability may occur in iliac crescent fracture-dislocation. The authors propose ORIF of the fracture-dislocation via a posterior approach. When initial surgery is not possible because of severe associated organ injuries, the authors propose transcondylar traction to allow reduction of the sacroiliac joint and ORIF at a later stage.

A novel percutaneous crossed screws fixation in treatment of Day type II crescent fracture–dislocation: A finite element analysis

“…Crescent fracture–dislocation of the sacroiliac joint is a relatively uncommon type of lateral compression injury [2], [3]. The main purpose of surgical intervention is to achieve early reduction and fixation of the associated fracture or dislocation of the pelvic ring.…”

“…Posterior iliac crescent fracture–dislocation involves the sacroiliac joint, which is a major weight-bearing articulation. If it is not appropriately treated, the potential for posttraumatic arthritis and chronic instability is considerable [3]. For the treatment of type II fracture, the previous literatures report that there are mainly two methods of open reductions and internal fixations (ORIFs) with anterior [4], [5] or posterior [6] approaching.…”

Comparison of percutaneous cross screw fixation versus open reduction and internal fixation for pelvic Day type II crescent fracture-dislocation: case-control study

“…Day et al divided crescent fracturedislocation (CFD) into three types: type I fracture involved the anterior 1/3 of the sacroiliac joint, type II fracture involved the middle 1/3 of the sacroiliac joint, and type III fracture involved the posterior 1/3 of the sacroiliac joint [8]. For the treatment of type II fractures, it was usually carried out by anterior or posterior approach open reduction and internal fixation (ORIF) [9][10][11]. But there was still some controversy about the surgical trauma and internal fixation methods [12].…”

Comparison of percutaneous cross screw fixation versus open reduction and internal fixation for Day type II crescent fracture-dislocation: Case-control study

“…Day et al divides crescent fracturedislocation (CFD) into three types: type fracture involves the anterior 1/3 of the sacroiliac joint, type fracture involves the middle 1/3 of the sacroiliac joint, and type fracture involves the posterior 1/3 of the sacroiliac joint [8]. For the treatment of type fractures, it is usually carried out by anterior or posterior approach open reduction and internal xation (ORIF) [9][10][11]. But there is still some controversy about the surgical trauma and internal xation methods [12].…”