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Fluoroscopic images of the sacroiliac joint alone are unable to identify simulated flexion or extension malreduction of the anterior pelvic ring in AO/OTA 61-B2.3 pelvic injuries

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Abstract

Purpose

Reduction of AO/OTA 61-B2.3 (APC2) pelvic fractures is challenging in the setting of anterior ring comminution. The anterior ring is visually much simpler to evaluate for flexion or extension hemipelvis deformity than the posterior ring, except in the setting of comminution, necessitating some other visual reference to judge hemipelvis reduction. We sought to test whether pelvic inlet and outlet fluoroscopy of the contours of the sacroiliac joint could be used in isolation to judge hemipelvis flexion or extension.

Methods

Symphyseal and anterior SIJ ligaments were cut (6 cadaveric pelvis). The symphysis was held malreduced to produce one centimeter flexion and extension deformity: 1 cm was selected to mimic a maximum clinical scenario. The SIJ was assessed using inlet and outlet fluoroscopy. The scaled width of the SIJ was assessed at the joint apertures and midjoint on both inlet and outlet views. Joint widths in flexion and extension were compared against joint widths measured on the reduced SIJ using paired t-tests.

Results

There was no statistical difference in the superior (p = 0.227, 0.675), middle (p = 0.203, 0.693), and inferior (p = 0.232, 0.961) SIJ widths between hemipelvis flexion or extension models against reduced SIJ on outlet views. There was no statistical difference in the anterior (p = 0.731, 0.662), middle (p = 0.257, 0.655), and posterior (p = 0.657, 0.363) SIJ widths between flexion or extension models against reduced SIJ on inlet views.

Conclusion

Inspection of SIJ width on inlet and outlet fluoroscopy cannot detect up to one centimeter of hemipelvis flexion or extension malreduction in the setting of AO/OTA 61-B2.3 (APC2) pelvic fractures with complex anterior injuries.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, University of California, San Francisco, 2540 23rd Street, Bldg 7, 3rd Floor, Rm 310, San Francisco, CA, 94110, USA

    Ashraf N. El Naga, Riley Knox & Meir T. Marmor

  2. Department of Orthopaedics & Rehabilitation, Oregon Health and Science University, Portland, OR, USA

    Zachary M. Working

  3. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA

    Paul Hoogervorst

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  1. Zachary M. Working
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Correspondence to Meir T. Marmor.

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The enclosed work was performed in compliance with modern ethical standards of publishing. The work was performed unfunded. The authors received no funding for the submitted work. [Corresponding/senior author] serves in a volunteer manner as a section editor at the Journal of Orthopaedic Trauma. The enclosed research was performed after ethical approval was obtained from the local institutions IRB.

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Working, Z.M., El Naga, A.N., Hoogervorst, P. et al. Fluoroscopic images of the sacroiliac joint alone are unable to identify simulated flexion or extension malreduction of the anterior pelvic ring in AO/OTA 61-B2.3 pelvic injuries. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-03841-w

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