J Korean Fract Soc.  2018 Jan;31(1):9-17. 10.12671/jkfs.2018.31.1.9.

Surgical Outcome of Posterior Pelvic Fixation Using S1, S2 Screws in Vertically Unstable Pelvic Ring Injury

• Yeo KH
• Moon NH
• Ahn JM
• Jeong JY
• Jang JH

• KMID: 2402709
• DOI: http://doi.org/10.12671/jkfs.2018.31.1.9

Abstract

PURPOSE
Iliosacral screw fixation is an effective and less invasive method that is used widely for the definitive treatment of unstable pelvic ring injuries. On the other hand, fixation failures after iliosacral screw fixation have been reported in vertically unstable pelvic ring injuries. This study examined the surgical outcomes of posterior pelvic fixation using S1 and S2 screws in vertically unstable pelvic ring injuries.
MATERIALS AND METHODS
Between January 2011 and April 2016, 17 patients with vertically unstable pelvic ring injuries who met the minimum 1 year follow-up criteria were treated with internal fixation using posterior pelvic S1 and S2 screws. Their mean age was 43.9 years. According to the AO/OTA classification, 10 patients had C1, 6 had C2, and 1 had C3 injuries. Surgical treatments of single or multiple steps, where necessary, were performed by two surgeons. The clinical and radiologic outcomes were assessed retrospectively using radiographs and medical records.
RESULTS
Overall, 16 patients had bone healing without screw loosening; however, one patient could not maintain anterior pelvic fixation because of an open fracture and deep infection in the anterior pelvic ring. Of five patients who complained of neurological symptoms after injury, three had partially recovered from their neurological deficit. At the last follow-up, the clinical outcomes according to the Majeed score were excellent in 5, good in 6, fair in 4, and poor in 2 patients. The postoperative radiologic outcomes by Matta and Tornetta's method were excellent in 5, good in 8, and fair in 4 patients. Malposition of the S2 screw was identified in one case. The mean time to union was 14.6 weeks after surgery.
CONCLUSION
S1 and S2 screw fixation can be an effective treatment option for posterior pelvic stabilization in vertically unstable pelvic ring injuries when considering the surgical outcomes, such as screw loosening and loss of reduction.

Keyword

Vertically unstable pelvic ring injury; Posterior pelvic fixation; S1 and S2 screw

MeSH Terms

Classification
Follow-Up Studies
Fractures, Open
Hand
Humans
Medical Records
Methods
Retrospective Studies
Surgeons

Figure

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  Fig. 1. Flow chart of the enrollment of patients treated with posterior pelvic fixation using S1 and S2 screws for vertically unstable pelvic ring injuries. PRI: pelvic ring injury, F/U: follow-up.

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  Fig. 2. Malposition of the S2 screw in the S1 foramen was identified in the axial (A), coronal (B), and sagittal (C) images of postoperative computed tomography. (D) Postoperative radiograph of the pelvic outlet view.

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  Fig. 3. (A) A 35-year-old female patient fell from a height and sustained a type C pelvic ring injury. (B) Posterior pelvic stabilization using S1 and S2 screws was performed 1 day after the injury. No further procedure was performed for the anterior pelvic ring because acceptable reduction of the fractures in the pubic rami was identified after posterior fixation. (C) No displacement occurred, and callus formation was observed at the 4-week follow-up. (D) The radiograph obtained at the 1-year follow-up showed complete bony union without complications.

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  Fig. 4. (A) Emergent external fixation and pelvic packing were performed in a 17-year-old male patient with a vertically unstable (type C) pelvic ring injury with an open wound. (B) Posterior pelvic fixation using S1 and S2 iliosacral screws and anterior fixation with rami screws were performed 2 days after the initial injury. (C) Rami screws and the external fixator were removed, and debridement and the insertion of antibiotic-impregnated cement beads were conducted because of a deep infection 4 weeks after the initial surgery. Sacroiliac screw loosening was identified. (D) Anterior pelvic plating using the modified Stoppa approach and posterior pelvic screw exchange were performed after the infection had subsided completely.

Reference

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