Original Article

Percutaneous screws CT guided to fix sacroiliac joint in tile C pelvic injury. Outcomes at 5 years of follow-up

¹ Department of Orthopedics and Traumatology, Azienda Ospedaliera “Gaetano Rummo”, Benevento, Italy
² Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
³ Division of Orthopedics and Trauma Surgery, University of Perugia, “S. Maria della Misericordia” Hospital, Perugia, Italy
⁴ Department of Trauma and Orthopaedics, The Royal National Orthopaedic Hospital, Stanmore, London, UK
⁵ Department of Orthopaedics, “Hospital General de Villalba”, 28400 Collado Villalba Spain

^* Corresponding author: drlordmec@gmail.com

Received: 19 May 2018
Accepted: 17 September 2018

Abstract

Introduction: The treatment of the sacroiliac joint (SIJ) vertical instability is a matter of current discussions and remains controversial. The aim of our study is the evaluation of the surgical management of SIJ vertical instability involving the use of cannulated screws introduced under CT guidance and local anesthesia.

Materials and methods: In the set time frame of 7 years, 96 poly-trauma patients with Tile's type C fracture of the pelvis with vertical instability of the SIJ were treated. The average distance between the two stumps was 73.4 mm (range: 43–100 mm). All patients were treated with anterior stabilization and subsequent stabilization with cannulated screws (Asnis^® Stryker^® 6 mm, an average length of 70 mm; range from 55 to 85 mm) of the sacroiliac fracture. The clinical and radiological follow-up was performed with follow-up plain radiograph and Majeed score (from 1 to 60 months after injury).

Results: The consolidation of pelvic fractures was obtained after an average of 63 days. The average Majeed score was as follows: 96 points at 1 month, 84 points at 3 months, 62 points at 6 months, 44 points at 12 months, 42 points at 24 months, 32 points at 36 months, 28 points at 48 months and 28 points at 60 months. Complications were as follows: not fatal deep vein thrombosis in five cases, skin infection at the entry point of the screws in six cases, screw breakage in one case and loosening of the screws in one case. Radiological evidence of fracture consolidation was achieved on average at 63 days. Forty-seven patients managed to get back to their pre-trauma employment at the end of the convalescence period.

Conclusions: Our results suggest that the stabilization of SI Tile type C fracture/dislocations with CT-guided percutaneous cannulated screws is a valid and feasible management option and associated with a low complication rate.