Functional outcome of unstable pelvic ring injuries after iliosacral screw fixation: single versus two screw fixation.

INTRODUCTION: A clinical series of patients was studied to compare the functional score after the use of a single versus two percutaneous iliosacral screws for unstable posterior pelvic ring fractures with or without anterior fixation with the aim to explore if the addition of a second screw would provide better results regarding the functional outcome score.

MATERIALS AND METHODS: This case series includes 77 patients with an average of 32.6 years who suffered unstable posterior pelvic ring fractures. Forty-six were Tile type C and 31 were Tile type B. Patients underwent closed reduction and were fixed using percutaneous fluoroscopic-guided iliosacral screws in the supine position with 1 screw in 50 fractures, 2 screws in 37 fractures, 2 fractures were fixed with plates after ORIF, and in 6 cases (out of the bilateral cases) the undisplaced side was unfixed. Postoperatively three patients were lost to follow up and 74 patients (84 posterior fractures fixed with screws) were followed up for a mean of 37.4 months (range 6-151 months) and were evaluated using the Majeed score (1989).

RESULTS: Clinical union occurred in all the patients, although in two cases posterior fixation failed and was revised. Radiologically excellent reduction was achieved in 55 patients (71.4%), good in 16 (20.8%), fair in 6 (7.8%) and none had poor reduction. Statistically; among 62 cases that completed the Majeed score evaluation at the last follow-up session, there was no significant difference p value 0.051 between two groups. We also compared Majeed score in Tile B and C fractures fixed with one versus two screws.

CONCLUSION: The addition of a second screw for posterior fixation did not show any statistically significant difference regarding functional outcome.

LEVEL OF EVIDENCE: Level IV clinical trial.