Radiographic and clinical results of iliosacral screw fixation of posterior pelvic ring injuries

Abstract

Background: Percutaneous iliosacral screw fixation is now the preferred option for posterior pelvic ring stabilization. Outcome reporting for this procedure remains inconsistent and unstandardized. We sought to evaluate the early outcomes of iliosacral screw fixation of unstable posterior pelvic ring injuries, with particular reference to leg-length differences. Methods: We retrospectively reviewed 28 patients who underwent percutaneous iliosacral screw fixation of posterior pelvic ring injuries between 2008 and 2012 at our trauma center. Only those with a minimum of 1-year follow-up, were included. Clinical outcomes were measured with EuroQol (EQ5D) and Majeed pelvic scores, and the radiographic outcomes were measured by the method of Matta and Tornetta. Results: The mean Majeed score was 83, mean EQ-Visual Analog Score (EQ-VAS) was 75; and the two scores correlated with statistical significance. Measured reductions of these injuries were good to excellent. Leg-length discrepancies improved initially but increased on further follow-up. This did not negatively affect the clinical outcome measures. The incidence of multiple surgical procedures in these patients was significantly associated with worse outcomes. Conclusions: Percutaneous iliosacral screw fixation of unstable posterior pelvic ring is performed with high patient-reported outcomes and excellent radiographically measured reductions at this center. We detected a trend towards increased leg-length difference on longer follow-up, but there was no detrimental effect on the clinical progress. We also found a previously unreported correlation between the Majeed score and the EQVAS score in our patient population.