Crescent Fracture-Dislocation of the Sacroiliac Joint: Use of Iliosacral Screws
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- Category: Vol. 85, September 2017
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Crescent Fracture-Dislocation of the Sacroiliac Joint: Use of Iliosacral Screws, SHERIF A. KHALED, MAHMOUD M. ABD EL-KARIM, AHMED H. ABD EL-AZEEM, HISHAM M. NAGUIB, MAHMOUD M. ABDALLAH, AHMED M.B. EL-SHAFIE, AHMED E.H. EL-SAIED, MOHAMED H. ABD EL-HAMID, AHMED O. SAKR, MOHAMED F. SAAD, REDA A. ABD EL-HAMID, EMAD EL-DIN I. EL-SHENAWY and MOHAMED H. KHASHABA
Abstract
Background: Crescent fracture dislocations are a well-recognized subset of pelvic ring injuries which result from a lateral compression force. They are characterised by disruption of the sacroiliac joint and extend proximally as a fracture of the posterior iliac wing. They are classically fixed using open reduction and plating. We hypothesized that iliosacral screws can provide stable fixation in Day type II and III types.
Methods: A clinical study was conducted with the aim of assessing the clinical results and functional scores of 64 patients 50 males and 14 females, age range 16 to 64 years who sustained 66 lateral compressions pelvic fractures operated between April 2000 and December 2015. X-rays and CT pelvis were used for all patients. We used a classification by Day et al., 2007 with three distinct types of crescent. Percutaneous Iliosacral Screws (IS) were used in 20 fractures, plates in 40 fractures, combined iliosacral screws with plates in 4 fractures and we added LCII (lateral compression screws) in 2 cases. The principal goal of surgical intervention was the accurate and stable reduction of the sacroiliac joint.
Results: Follow-up ranged from 4 to 126 months with an average of 40.6 months, the clinical results were good in all cases, healing rate was 100%, 2 cases died and one case lost and the average Majeed functional score was 83.93 in 61 patients.
Conclusion: Percutaneous IS screw fixation is a good option for types II and III crescent fractures, with fewer complications than the plate option. While plating should be used for type I crescent fracture.
Level of Evidence: Level IV-case series.