Management of crescent fracture–dislocation of the sacroiliac joint: iliosacral screws versus plate fixation

Abstract

Background Crescent fracture–dislocations are a well-recognized subset of pelvic ring injuries, which result from a lateral compression (LC) force. They are characterized by the disruption of the sacroiliac joint and extend proximally as a fracture of the posterior iliac wing. They are classically fixed using open reduction and internal fixation using plates and screws. We hypothesized that iliosacral screws (IS) can provide stable fixation in Day type II and Day type III. Patients and methods This clinical study was conducted with the aim of assessing the clinical results and functional scores of 43 patients (34 male and nine female patients). Their ages ranged from 16 to 64 years. The study included 43 patients who had sustained LC pelvic fractures (44 fractures) and had been operated upon between April 2000 and June 2010 (one patient had sustained bilateral fractures). Radiography and computed tomography of the pelvis were obtained for all patients. The classification by Day and colleague was used with three distinct types of crescents. Percutaneous IS alone were used in 20 fractures; a plate was used in 22 fractures, and two fractures were fixed with both plates and IS. LC II (LC screws) were added in two cases. The average follow-up period was 53 months (range: 4–126 months). Two patients died and one patient was lost to follow-up. The principal goal of surgical intervention was the accurate and stable reduction of the sacroiliac joint. Results Intraoperatively, there was no significant blood loss in cases treated with IS; the average blood loss in cases treated with open reduction and internal fixation using the plate was 600 ml (range: 200–1000 ml). The operative time was shorter for cases treated with IS (40 min; range: 30–60 min) than that for cases treated with plates (100 min; range: 60–150 min). The difference was statistically significant with a P-value of less than 0.001. The clinical results were good in all cases; there were no wound complications, neurological complications, or residual rotational deformity of the limb. The healing rate was 100%. The Majeed score was used for functional evaluation, and the mean score for the 40 patients was 86.2 points (range: 53–100 points); 26 (65%) patients scored greater than 85 points (excellent), 12 (30%) patients scored 66–84 points (good), and two (5%) patients scored 53 and 64 points (poor). The average Majeed score for the group fixed with plates was 84.56 points (range: 66–100 points), and it was lower than the Majeed score for IS, which was 87.2 points (range: 53–97 points). However, the difference was not statistically significant, with a P-value of 0.404. The average Majeed score for cases fixed with plates and IS was 91.5 points (range: 90–93 points). Discussion and conclusion Percutaneous IS fixation is a good option for types II and III crescent fractures, with lesser blood loss and shorter operative time compared with plate fixation. The functional outcome of the cases fixed with IS was better; however, the difference was not statistically significant. Level of evidence The level of evidence was IV (case series).