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Identification of subtle residual sacroiliac joint flexion and extension malreductions in AO/OTA 61-C1.2 (APC3) pelvic injuries after provisional anterior ring reduction

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Hemipelvis reduction in the setting of AO/OTA 61-C1.2 (APC3) pelvic injuries can be challenging. A common strategy is to provisionally reduce or fix the anterior ring prior to definitive fixation of the posterior ring. In this scenario, it is difficult to assess whether residual sacroiliac joint (SIJ) widening is due to hemipelvis flexion/extension or lateral displacement. This simulation sought to identify a radiographic marker for posterior ilium flexion or extension malreduction in the setting of a reduced anterior ring.

Methods

Symphyseal and both anterior and posterior SIJ ligaments were cut in 8 cadaveric pelvis. The symphysis was reduced and wired. One centimeter of posterior flexion or extension at the SIJ was created to mimic the clinical scenario of hemipelvis flexion or extension malreduction, and a lateral compressive force was applied. SIJ widening and the direction of anterior or posterior ileal displacement relative to the contralateral joint were assessed via inlet views. SIJ widening and the direction of cranial or caudal ileal displacement were assessed using outlet views. Comparisons between flexion and extension models used Fisher’s exact test.

Results

On outlet views, all flexed hemipelvis demonstrated caudal ileal translation at the superior SIJ, in contrast to all extended hemipelvis demonstrated cranial translation (p < 0.0005); the scenarios were easily distinguishable. Conversely, inlet imaging was unable to identify the direction of malreduction. Flexion/extension scenarios resulted in similar amounts of SIJ widening.

Conclusion

Residual flexion and extension hemipelvis malreductions in APC3 injuries after provisional anterior fixation can be differentiated by the direction of ileal displacement at the superior SIJ on the outlet view.

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Funding

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. [second author] serves in a volunteer manner as a section editor at the Journal of Orthopedic Trauma.

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Authors and Affiliations

  1. San Francisco—Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, 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 & 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. Ashraf N. El Naga
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  2. Zachary M. Working
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Correspondence to Meir T. Marmor.

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El Naga, A.N., Working, Z.M., Hoogervorst, P. et al. Identification of subtle residual sacroiliac joint flexion and extension malreductions in AO/OTA 61-C1.2 (APC3) pelvic injuries after provisional anterior ring reduction. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-03840-x

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