[Evaluation of percutaneous iliosacral screws for unstable pelvic fractures].

OBJECTIVE: To evaluate the effectiveness of percutaneous fixation with iliosacral screw in the management of unstable pelvic fractures.

METHODS: From March 2003 to January 2007, 15 patients with unstable pelvic fractures were treated by percutaneous fixation with iliosacral screws. There were 6 males and 9 females, aged 21-56 years. Fractures were caused by traffic accident in 8 cases, high falling in 6 cases and crushing injury in 1 case. The disease course ranged from 4 hours to 3 days. Of 15 patients, 7 had fractures of pubium and sacrum; 2 had fractures of ilium and sacrum; 4 had dislocation of sacroiliac joint with fractures of pubic rami; and 2 had dislocation sacroiliac joint with fracture of sacrum of pubium. Anterior fixation was performed by means of plating in 3 cases, by external fixation in 7 cases, and by both in 5 cases.

RESULTS: The blood loss was from 1,000 to 1,500 mL in 4 patients with acetabular fracture and about 50 mL in the others. The average operative time was 153.6 minutes (range, 60-305 minutes). Fifteen patients were followed up 6 months to 3 years with an average of 18 months. According to Matta criterion for fracture reduction, the results were excellent in 14 cases and good in 1 case. After a follow-up of 28.8 months, fracture union was achieved in all patients. Screw loosening occurred in 1 case, pain of lumbosacral region in 3 cases after tiredness and mild claudication in 2 cases. Nine patients returned to their occupation, three patients changed occupation, and 3 patients could not work at last follow-up. According to Majeed functional scoring, the results were excellent in 11 cases and good in 4 cases.

CONCLUSION: Percutaneous iliosacral screw fixation is a useful method in treatment of unstable pelvic fracture.