Posterior hinge fixation for the treatment of unstable traumatic sacroiliac joint injuries

Abstract

IntroductionPosterior hinge fixation (PHF) is a sacroiliac joint fixation method indicated for the surgical treatment of unstable pelvic ring fractures (tile C). HypothesisPHF yields good functional outcomes based on the Majeed score at more than 1 year of follow-up. MethodsA single-center, retrospective study of patients who had a Tile C pelvic ring fracture, who were operated by PHF and who were evaluated at a minimum follow-up of 1 year. The functional outcome was determined using the Majeed score and pain was evaluated by the patients using a visual analog scale (VAS). The preoperative, intraoperative and postoperative data, complications and sequelae were documented. A CT-scan was done at least 1 year after the surgical treatment to determine the SI joint's reduction and fusion. ResultsIncluded were 22 patients (59% men) who had a mean age of 37.3±11.9 years; 21 of these patients were reviewed at a mean of 4.8±4 years. The mean Majeed score at the final assessment was 76.4 points±15.3, with 24% of patients having excellent results (n=5), 53% having good results (n=11), 19% having average results (n=4) and 5% having poor results (n=1). The mean pain level on VAS was 28±23mm. Of the eight surgical site infections, seven occurred in the PHF (88%). CT-scans taken at 1 year postoperative were compared to the preoperative scans. The pelvic opening was reduced by −9±6 (p<0.01), SI diastasis by −11mm±9 (p<0.001), vertical displacement by–7mm±8 (p<0.001), symphysis opening by −15mm±15 (p<0.001), median transverse diameter by −10mm±9 (p<0.001) and bispinal diameter by −5mm±7 (p<0.001). SI fusion was confirmed in 43% of patients (n=9). ConclusionPHF is a surgical instrumentation method that provides satisfactory long-term reduction of Tile C pelvic ring fractures. The clinical outcomes are good or excellent in 77% of cases. The perioperative morbidity is marked by surgical site infections, all of which healed. Level of evidenceIV; retrospective, non-comparative cohort study.