Outcome analysis of unstable posterior ring injury of the pelvis: Comparison between percutaneous iliosacral screw fixation and conservative treatment

Abstract

Background: Unstable posterior ring injuries of the pelvis are a challenge to pelvic surgeons, and their treatment has been controversial. The functional outcomes of such injuries following either percutaneous iliosacral screw fixation or conservative treatment remain to be elucidated. Methods: We conducted a retrospective analysis of 32 consecutive patients with unstable pelvic ring injuries who were treated with percutaneous placement of iliosacral screws (group 1) or conservative means (group 2) from January 2002 to September 2009. Radiographic, clinical, and functional outcomes were compared between the two treatment groups. Results: Patients who underwent percutaneous iliosacral screw fixation after pelvic trauma had better functional results than those treated conservatively, as per the Majeed grading system. In addition, patients in group 1 demonstrated better results for general health and mental health on the 36 item Short Form Health Status Survey. Patients in group 1 also demonstrated less residual displacement on radiography at 1 year follow up than those in group 2. Finally, patients in group 1 had better pain relief at 1 month and 1 year follow ups than those in group 2. Conclusions: Percutaneous iliosacral screw fixation for unstable posterior pelvic ring injuries results in less residual displacement at medium term follow up, and better pain relief at short and medium term follow up, than does conservative treatment. Better functional outcomes were observed at 1 year follow up as compared with conservative treatment.

Keywords

• Percutaneous iliosacral screws
• pelvic ring injury
• pelvis fracture
• sacrum fracture sacroiliac joint disruption