Sacroiliac Joint Dislocation Research Articles

The incidence of and factors affecting iliosacral screw loosening in pelvic ring injury.

Iliosacral screw fixation has been commonly used for stabilization of the posterior ring in unstable pelvic fractures. However, loosening of the screw may develop with or without redisplacement of the fracture. This study was undertaken to evaluate the incidence of iliosacral screw loosening and to identify its predictive factors. In total, 110 patients whose posterior pelvic ring was stabilized with iliosacral screws were enrolled. These included 9 cases of anteroposterior compression, 64 cases of lateral compression, and 37 cases of vertical shear (VS) injuries. Among those with posterior pelvic ring injuries, 95 had sacral fractures (zone I: 52, zone II: 43) and 15 had sacroiliac joint dislocations. The screws were fixed to the anterior one-third region of the first sacral (S1) body in 46 cases, and to the middle one-third region in the remaining 64 cases. If loosening of the iliosacral screw influenced the pelvic ring stability, it was considered a failure. The relationship between iliosacral screw loosening and the possible influencing factors were analyzed. Nineteen patients (17.3%) were found to have loosening of the iliosacral screw at a mean 25.3days postoperatively. Of these, 13 patients (11.8%) had failure of the screws. The incidence of iliosacral screw loosening was significantly higher in those with VS injury (29.7%, p=0.014), in those with screw fixed to the middle one-third region of the S1 body (23.4%, p=0.044), and in those with VS injury combined with zone II sacral fracture (43.5%, p=0.019). With respect to failure of the iliosacral screw, patients with VS injury also had a higher incidence of failure (21.6%, p=0.036). Our findings demonstrate that cases with VS injuries are prone to screw loosening, especially when combined with zone II sacral fracture. Accordingly, alternative fixation methods should be considered in such cases.

Rent in the Vent: A Rare Event: Parturition-Induced Rupture of Pubic Symphysis and Dislocation of Sacroiliac Joint After Spontaneous Vaginal Delivery.

Rent in the Vent: A Rare Event: Parturition-Induced Rupture of Pubic Symphysis and Dislocation of Sacroiliac Joint After Spontaneous Vaginal Delivery.

Biomechanical study of four kinds of percutaneous screw fixation in two types of unilateral sacroiliac joint dislocation: A finite element analysis

ObjectiveTo compare the biomechanical stability of four different kinds of percutaneous screw fixation in two types of unilateral sacroiliac joint dislocation. MethodsFinite element models of unstable Tile type B and type C pelvic ring injuries were created in this study. Modelling was based on fixation with a single S1 screw (S1-1), single S2 screw (S2-1), two S1 screws (S1-2) and a combination of a single S1 and a single S2 screw (S1–S2). The biomechanical test of two types of pelvic instability (rotational or vertical) with four types of percutaneous fixation were compared. Displacement, flexion and lateral bend (in bilateral stance) were recorded and analyzed. ResultsMaximal inferior translation (displacement) was found in the S2-1 group in type B and C dislocations which were 1.58mm and 1.90mm, respectively. Maximal flexion was found in the S2-1 group in type B and C dislocations which were 1.55° and 1.95°, respectively. The results show that the flexion from most significant angulation to least is S2-1, S1-1, S1-2, and S1–S2 in type B and C dislocations. All the fixations have minimal lateral bend. ConclusionOur findings suggest single screw S1 fixation should be adequate fixation for a type B dislocation. For type C dislocations, one might consider a two screw construct (S1–S2) to give added biomechanical stability if clinically indicated.

Anterior Sacroiliac Dislocation: A Case Report and Review of the Literature.

Injuries to the sacroiliac joints are most commonly caused by high-energy trauma. Orthopaedic traumatologists frequently treat sacroiliac dislocations and fracture-dislocations as part of the spectrum of pelvic ring injuries. Typical sacroiliac joint dislocations are posterior; anterior dislocations are extremely rare. As with posterior dislocations, these are high-energy injuries with concomitant visceral, neurologic, and other osseous injuries. We describe a case of anterior sacroiliac dislocation that was treated with a closed reduction and percutaneous fixation in a trauma patient with multiple injuries. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A twenty-one-year-old unrestrained driver was involved in a head-on collision with a tree at an unknown speed after reportedly attempting to avoid pedestrians in the road. She was initially evaluated in Mexico and was transferred to our level-I trauma center twelve hours after the accident. On admission to the trauma bay, the initial vital signs were blood pressure of 122/70 mm Hg, heart rate of 94 bpm, respiration of 24 bpm, and oxygen saturation of 100% on 2 L per nasal cannula. The initial hemoglobin and hematocrit levels were 10.9 g/dL and 31.6%, respectively. On examination, the patient was alert and oriented with a Glasgow Coma Scale score of 15. The spine was nontender, but she did have tenderness to palpation in the left sacroiliac region with accompanying ecchymosis posteriorly. The pelvis was unstable with lateral and anteroposterior compression. The patient had complete loss of sensation and motor function of the left lower extremity, although she had normal peripheral pulses in all four extremities. Perineal examination revealed no open wounds; however, there was left labial swelling and ecchymosis. A Foley catheter had been placed prior to arrival, and gross blood was identified in the urine. The stool guaiac test was negative, …

Lumbar plexus injury in an anterior fracture dislocation of sacroiliac joint: a case report and review of literature

Displaced unstable pelvic fractures are commonly associated with disruption of the osteoarticular junction of the sacroiliac joint. Posterior sacroiliac dislocation are commonly reported but there are only few reports the anterior type of sacroiliac dislocation where the iliac bone fractures and displaces anterior to sacrum, often in combination with fractures of pubic rami and symphyseal injuries. We present a case of an anterior type of sacroiliac fracture dislocation which was associated with a lumbar plexus injury involving both motor and sensory components. Preoperative neurological assessment was done by MRI scan. The tented nerve roots were explored and decompressed surgically, and sacroiliac fixation was done after reduction in the fracture and joint.

Isolated anterior unilateral sacroiliac dislocation without pubic arch disjunction

Sacroiliac joint dislocations frequently occur in a context of high-energy polytrauma. When there is disruption of the pelvic ring, sacroiliac joint displacements are more often posterior and combine two lesions: either lesions of the pubic arch as well as the posterior arch or bilateral lesions. The case we report here lacks these two characteristics. This is an isolated unilateral sacroiliac dislocation with no opening lesion of the pubic symphysis or fracture of ilio- or ischiopubic rami and with anterosuperior displacement. After emergency reduction of the dislocation, the secondary fixation was not performed, due to initial hemodynamic instability compounded by deteriorating central nervous system condition.

The application of a computer-assisted thermoplastic membrane navigation system in screw fixation of the sacroiliac joint – A clinical study

BackgroundWe inserted iliosacral screws with the aid of a computer-assisted thermoplastic membrane navigation (CATMN) system which is widely used for the accurate and repeatable location tumour in radiation therapy. We hypothesised that application of the CATMN system on IS screws’ insertion will provide a superior result to conventional fluoroscopic imaging with less operative time, more accuracy and lower complication rates. MethodsWe prospectively evaluated 26 consecutive patients who suffered from sacroiliac joint fractures and dislocations (type C, Tile classification) from April 2007 to June 2010 in our hospital. Patients were randomised into two groups: 13 patients in control group and 13 patients in CATMN groups. After operation, inlet and outlet X-ray views and computed tomography (CT) scanning were performed to confirm and compare the screw positions. The operative time, blood loss and accuracy (measured with postoperative CT) were analysed between groups. ResultsIn the control group, 18 screws were placed in 13 patients with conventional fluoroscopic technique; two of 18 (11.1%) screws were misplaced. The average intra-operative blood loss was 145.4±112.0ml, and operation time was 619.2±199.5s. In the CATMN group, 21 screws were placed in 13 patients with the application of the CATMN system. All 21 screws were in safe zones. The average intra-operative blood loss was 46.2±24.3ml and the operation time was 353.8±111.2s. Operative time and blood loss were reduced significantly with the CATMN system (p<0.05). ConclusionApplication of CATMN system has high accuracy in treating sacroiliac joint dislocations and provides a new alternative method for guidance of the IS screw placement.

Sequentially reduction and fixation of the pubic rami fractures and sacroiliac joint dislocation by the iliac screw Galveston technique

Sequentially reduction and fixation of the pubic rami fractures and sacroiliac joint dislocation by the iliac screw Galveston technique

Anterior Pelvic Plating and Sacroiliac Joint Fixation in Unstable Pelvic Ring Injuries

PurposeTo analyze the effectiveness of anterior pelvic plating and subsequent percutaneous sacroiliac joint screw fixation in patients with unstable pelvic ring injuries.Materials and MethodsThirty-two patients were included with twenty-one males and eleven females. The mean age was 41 years (range, 19-76). The mean follow-up period was 51 months (range, 36-73). According to AO-OTA classification, there were 11 cases of B2 injuries, 8 cases of B3 injuries, 9 cases of C1 injuries, 2 cases of C2 injuries and 2 cases of C3 injuries. In the posterior lesions, there were 20 cases of sacral fractures and 12 cases of sacroiliac joint disruptions or dislocations. Anterior pelvic plating and subsequent percutaneous sacroiliac joint fixation were performed.ResultsThe clinical results were 16 cases of excellent, 10 cases of good, 4 cases of moderate and 2 cases of poor functional results. The 2 cases out of 7 moderate reductions had poor functional results with residual neurologic symptoms. The radiological results were 16 cases of anatomic, 9 cases of nearly anatomic and 7 cases of moderate reduction. All patients were healed except 3 cases of nonunion at the pubic ramus. The complications encountered were 3 cases of screw loosening, 2 cases of anterior plate breakage and 1 case of postoperative infection.ConclusionIn patients with unstable pelvic ring injuries, anterior pelvic plating and subsequent percutaneous sacroiliac joint screw fixation may be a useful surgical option. The radiological results and residual neurologic symptoms had effects on its functional results.

Treatment of sacroiliac joint dislocation and sacral fracture

Treatment of sacroiliac joint dislocation and sacral fracture

Bilateral Sacroiliac Joint Dislocation (Anterior and Posterior) With Triradiate Cartilage Injury: A Case Report

Pediatric sacroiliac joint injuries are uncommon. Significant pelvis ring disruptions in children are rare, and their management is complicated by patient size, differences in bony architecture, and future growth and remodeling potential. We present a rare case of anterior sacroiliac joint dislocation associated with triradiate cartilage injury with a posterior sacroiliac dislocation on the contralateral side. This appears to be the first such case reported in the literature.

Anterior Sacroiliac Dislocation

Although much has been written on the evaluation and management of pelvic ring injuries, only a single case of anterior sacroiliac joint dislocation exists in the literature and was reported in 1976. This article describes 2 additional cases, 1 of a pure anterior sacroiliac dislocation in a 25-year-old man, and 1 of an anterior sacroiliac fracture-dislocation in an 18-year-old man, each treated by a different orthopedic traumatologist at neighboring trauma centers. Both cases were the result of high-energy trauma, and both patients had significant complications resulting from severity of their injuries, including wound dehiscence and causalgia in 1 case and persistent L5-S1 paresthesias and paresis in the other. Closed reduction can be attempted, but in our experience was unsuccessful even with the use of external fixation pins for leverage. We recommend open reduction by an orthopedic traumatologist who will perform definitive fixation. The decision to use an anterior external fixation frame to assist during the patient's resuscitation should be based on the patient's hemodynamic status and concomitant injuries. Despite a high complication rate, operative intervention can return patients to a functional level with minimal residual pain.

A Method for Computing General Sacroiliac Screw Corridors Based on CT Scans of the Pelvis

Sacroiliac (SI) joint dislocations and sacral fractures of the pelvis can be stabilized by SI screws; however, screw insertion into a sacral isthmus region is risky for the adjacent neurovascular structures. Therefore, shape analyses of general SI screw corridors or safety zones are of great surgical interest; however, before such analyses can be conducted, a method for computing 3D models of general SI corridors from routine clinical computed tomography (CT) scans has to be developed. This work describes a method for determining general corridors in pelvic CT data for accurate screw placement into the first sacral body. The method is implemented with the computer language C++. The pelvic CT data are preprocessed before the presented algorithm computes a model of the 3D corridor volume. Additionally, the two most important parameters of the algorithm, the raster step and the virtual SI screw diameter, have been characterized. The result of the work is an algorithm for computing general SI screw corridors and its implementation. Additionally the influences of two important parameters, the raster step and the SI screw diameter, on corridor volume precision and computation time have been quantified for the test sample. We conclude that the method can be used in further corridor shape analyses with a large number of pelvic CT data sets for investigating general SI screw corridors and clinical consequences for the placements of the screws. Implementation of the presented software algorithm could also enhance performance of computer-assisted surgery in the near future.

Idiopathic bilateral ureteric entrapment within the sacroiliac joints causing bilateral hydroureteronephrosis

Bilateral ureteric entrapment is known in conditions such as retroperitoneal fibrosis, post-aortic aneurysm repair, retroperitoneal lymphadenopathy, and tumour. Unilateral ureteric entrapment has been reported in cases of hernia 1 Weintraub J.L. Pappas G.M. Kirsch M.J. et al. Percutaneous reduction of ureterosciatic hernia. AJR Am J Roentgenol. 2000; 175: 181-182 Crossref PubMed Scopus (22) Google Scholar and in cases of young patients with pelvic trauma. 2 Konety B.R. Xerogeanes J. Corral D.A. et al. Ureteral entrapment in the sacroiliac joint in pelvic trauma. J Trauma. 1996; 41: 150-151 Crossref Scopus (7) Google Scholar , 3 Shetty R. Thomas J. Rao S. Ureteral entrapment in traumatic sacroiliac joint dislocation — a rare injury. Indian J Urol. 2001; 18: 75-77 Google Scholar , 4 Noakes J.E. Wese F.X. Churchill B.M. Ureteral entrapment injury in blunt pelvic trauma: a case report. J Urol. 1982; 127: 764-765 PubMed Google Scholar However, ureteric entrapment within the sacroiliac joints is a very rare condition. We present a case of bilateral ureteric entrapment within the sacroiliac joints in an elderly lady with no known history of trauma. To the authors’ knowledge, this has not been previously reported in the scientific literature.

The anterior dislocation of the sacroiliac joint: a report of four cases and review of the literature and treatment algorism

Pelvic fractures are an uncommon injury in pediatric trauma patients, but the morbidity and mortality associated with these injuries can be profound. Of the posterior pelvic ring disruptions, the posterior dislocation of sacroiliac joint, which is the traditional dislocation of the sacroiliac joint, occurs in most incidences of pediatric trauma patients. There are few reports, however, on the "anterior" dislocation of sacroiliac joint, in which the ilium dislocates anterior to the sacrum and often combines with symphyseal diastasis and fractures of pubic rami and ilia. The distinct fracture-dislocation of sacroiliac joint is a subtype of completed posterior pelvic fracture. Literature review contains little information about such type of dislocation. We present four cases of pediatric trauma patients with the "anterior" dislocation of sacroiliac joint. After a thorough literature review of existing classification of pelvic fractures, we name it as the anterior dislocation of sacroiliac joint.

Pelvic ring fracture—Dislocation in a 2400-year-old Etruscan man

Some ancient texts, such as Homer's Iliad and the Book of Genesis in the Holy Bible, both of the IX century b.c., include descriptions of acetabular fractures. 4 Homer F.R. The Iliad. Winner of the Academy of American Poets. London Translation, 1991 Google Scholar , 3 Genesis. vol. 32. Holy Bible New International Version, London1997 Google Scholar Between the VIII and the III century b.c, Etruscan people settled in Italy before Romans. In an Etruscan archaeological site a skeleton was found inside a tomb with a pelvic ring fracture. It is a vertical shear fracture with a sacro-iliac joint dislocation and a diastasis of pubic symphysis. This man lived in the V century b.c. His skeleton represents the most ancient evidence of a pelvic ring fracture we know of.

Legal assessment of fractures and ruptures of the pelvis

Since it is very difficult to arrive at a complete picture of the very varied effects of fractures and ruptures in the pelvic region, the few studies that have so far dealt with the assessment of injuries to the pelvic girdle have been unable to develop any uniform guidelines. An analysis of the clinical, radiological and in particular CT studies that have been published to date shows that there is a well-defined relationship between clinical and radiological symptomatology. This allows cases to be assessed expertly and objectively. Where there are unstable pelvic girdle fractures, follow-up examinations can use the extent of symphyseal diastasis and the dislocation of one or both halves of the pelvis in relation to the sacrum as a yardstick to assess the effects of injury on the posterior pelvic girdle and their consequences - effects which would otherwise be difficult to detect. Only where there are symphyseal diastases of more than 15 mm with degenerative alterations of the sacroiliac joint and permanent dislocation of one half of the pelvis does an impairment of earning capacity of 20% apply. Impairment-of-earning-capacity rates of 30-40% are appropriate in cases with completely unstable pelvic girdle fractures involving dislocation of both halves of the pelvis and posttraumatic arthritis in the sacroiliac joints. All other pelvic girdle or iliac wing fractures qualify for a maximum 10% reduction in earning capacity, even if the symphysis has become rigid.

Minimum 1-Year Follow-Up for Patients With Vertical Shear Sacroiliac Joint Dislocations Treated With Iliosacral Screws: Does Joint Ankylosis or Anatomic Reduction Contribute to Functional Outcome?

To prospectively analyze a homogenous group of trauma patients with pure sacroiliac (SI) joint dislocations treated with iliosacral screws (ISS), with specific attention to functional outcome and its correlation with the presence or absence of SI joint ankylosis and quality of reduction. Retrospective chart and radiographic review of initial injury and treatment, with prospective long-term evaluation of radiographs, computed tomography (CT) scans, and functional assessments. Level One Regional Trauma Center. Twenty-three patients who were skeletally mature with traumatic vertical shear pelvic injuries associated with a pure SI joint dislocation. Treatment consisted of closed or open reduction in the supine or prone position and insertion of a single ISS placed percutaneously for the fixation of the posterior ring injury. Each patient was evaluated for functional outcome using version 2 of the Short-Form 36 (SF-36v2), the short version of the Musculoskeletal Functional Assessment (sMFA), the Iowa Pelvic Scoring System, and the Majeed Pelvic Scoring System. Additionally, at the follow-up visit, each patient received plain radiographs of the pelvis and CT scanning of the pelvis. Minimum follow-up was 1 year postindex procedure (13-120 months). In this subset of patients with pure SI dislocations treated with ISS alone, anatomic reduction was the only predictor of a more favorable functional outcome (P = 0.04). Specifically, SI joint ankylosis did not affect functional outcome in these patients. Based on the results of this study, in the treatment of vertically displaced, pure SI joint dislocations, an anatomic reduction (whether closed or open), followed by ISS fixation should be the goal because this appears to be the only predictor of a more favorable functional outcome in patients with this injury. Complete SI joint ankylosis appears to have no effect, either positive or negative, on functional outcome in these patients.

Fracture dislocation of sacroiliac joint associated with triradiate cartilage injury in a child: a case report

We report a very rare injury of a 8-year-old girl with sacroiliac fracture dislocation and triradiate cartilage separation. After the restoration of the sacroiliac joint by open means, reduction of the separated cartilage was seen. At 20 months follow-up, an osseous bridging at the triradiate cartilage and mild coxa valga deformity developed. We think that every child with serious sacroiliac joint injury should be evaluated for associated triradiate cartilage injury and followed to skeletal maturity for late complications such as acetabular dysplasia, hip subluxation and pelvic asymmetry.

Bilateral Sacroiliac Joint Dislocation in an Adolescent after a Skiing Accident.

A bilateral sacroiliac joint (SI joint) dislocation is a rare injury pattern, in contrast to bilateral fracture dislocations of the SI joint. The incidence of pelvic dislocation of the SI joint without significant bone structural damage would most likely be observed in young children or adolescents after receiving a blunt, high energy impact. These young patients often suffer life threatening injuries to the intestines, neural or vascular systems or severe injury of the urinary tract. In these scenarios, plain projection radiographic imaging often leads to an inconclusive diagnosis making computer tomography indispensable to plan the treatment strategy. These strategies vary and the optimal approach is a subject to dispute. A surgical treatment of these injuries should ensure an immediate primary stability to allow early ambulation. The following study reports a unique trauma pattern with an isolated bilateral SI dislocation without fracture of the posterior or anterior pelvic ring nor concomitant injuries. This rare injury is a consequence of a pure vertical shear impact. This case report describes a technical pitfall of the iliolumbar transfixation and a solution to the problem. A dorso-ventro-dorsal approach, which utilizes both iliolumbar transfixation and ventral bilateral double plating osteosynthesis will be presented.