Vertically Unstable Pelvic Fractures Fixed with Percutaneous Iliosacral Screws: Does Posterior Injury Pattern Predict Fixation Failure?

Abstract

Percutaneous iliosacral screw fixation is a useful technique in the management of vertically unstable pelvic fractures, but a vertical sacral fracture should make the surgeon more wary of fixation failure and loss of reduction.

Do Transsacral-transiliac Screws Across Uninjured Sacroiliac Joints Affect Pain and Functional Outcomes in Trauma Patients?

“…Zhao et al showed that TSTI provides superior biomechanical fixation than IS screws in finite element analysis and cadaveric models [18,19]. This type of fixation has been proposed as a solution to previous failures of IS screws with vertically unstable sacral fractures according to Griffin et al [4]. A few small retrospective studies have shown good clinical results with TSTI screws [1,3].…”

“…TSTI screws were generally more likely to be used in patients with vertically unstable injuries of the posterior ring as a result of previous reports of failures [4] or in osteopenic patients; however, the decision to use IS or TSTI fixation was made according to the judgment of the attending traumatologist. The techniques used were described in the technique paper by Gardner and Routt [3].…”

“…Transsacral-transiliac screws anchor into iliac cortical bone on both sides of the pelvis, whereas standard iliosacral screws are placed in the less dense cancellous sacral ala [3]. Loss of reduction with iliosacral (IS) screw(s) and resultant malunion have been reported in 44% of vertically unstable ring injuries where only IS screws were used [3,4,6]. Transsacral-transiliac (TSTI) screws have provided a potential solution for these challenges because longer screws placed across six cortices gain better fixation than IS screws ending in the cancellous bone of the central sacrum, and TSTI screws create a longer level arm to resist vertical displacement for unilateral injuries.…”

Modified triangular posterior osteosynthesis of unstable sacrum fracture

“…Recently, Griffin et al [4] have shown that the use of percutaneous iliosacral screw fixation may be a good technique to manage vertically unstable sacral fractures, but there are some anatomic limitations, and in order to prevent fixation failure prolonged bed rest is often necessary.…”

Application triangular osteosynthesis for vertical unstable sacral fractures

“…Operative treatment should reconstruct the fracture anatomy, decompress the nerves, and achieve possibly early mobilization and weight-bearing. Kinds of internal fixation instruments that had been proposed to reconstruct the post pelvic ring include posterior small plates [5], percutaneous iliosacral screws [6,7], transiliac bars [8][9][10], and sacral rods [11]. However, none of these fixation instruments can resist vertical shear forces, provide unrestricted weightbearing, and secure mobilization after operation.…”