Analysis of sacro-iliac joint screw fixation: does quality of reduction and screw orientation influence joint stability? A biomechanical study
Treatment of posterior pelvic ring injuries is frequently associated with pain or/and high mortality rates. Percutaneous sacro-iliac (SI) screw fixation has proved to be one of the methods of choice, providing minimal operative time, blood loss and wound-related morbidity. However, fixation failures due to secondary fracture dislocation or screw backing out have been reported. There is a little knowledge regarding the impact of varying screw orientation and quality of reduction on the fixation strength.
The purpose of the present study was biomechanical investigation of joint stability after SI screw fixation and its dependence on quality of reduction and screw orientation.
Thirty-two artificial hemi-pelvices were assigned to four study groups and simulated SI dislocations were fixed with two SI screws in oblique or transverse screw orientation and anatomical or non-anatomical reduction in group A (oblique/anatomical), B (transverse/anatomical), C (oblique/non-anatomical) and D (transverse/non-anatomical). Mechanical testing was performed under progressively increasing cyclic axial loading until fixation failure. SI joint movements were captured via optical motion tracking. Fixation performance was statistically evaluated at a level of significance p = 0.05.
The highest cycles to failure were observed in group A (14038 ± 1057), followed by B (13909 ± 1217), D (6936 ± 1654) and C (6706 ± 1295). Groups A and B revealed significantly longer endurance than C and D (p ≤ 0.01).
Different screw orientations in the presented model do not influence substantially SI joint stability. However, anatomical reduction is not only mandatory to restore a malalignment, but also to increase the SI screw fixation strength and prevent fixation failures.
KeywordsPosterior pelvic ring injuries Sacro-iliac screw fixation Hemi-pelvis Sawbones Joint stability
The authors are not compensated and there are no other institutional subsidies, corporate affiliations, or funding sources supporting this work unless clearly documented and disclosed. This investigation was performed with the assistance of the AO Foundation via the AOTRAUMA Network (Grant No.: AR2013_10).
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to disclose.
- 11.Citak M, Hufner T, Geerling J, Kfuri M Jr, Gansslen A, Look V, Kendoff D, Krettek C (2006) Navigated percutaneous pelvic sacroiliac screw fixation: experimental comparison of accuracy between fluoroscopy and Iso-C3D navigation. Comput Aided Surg: Off J Int Soc Comput Aided Surg 11(4):209–213. doi: 10.3109/10929080600890015 Google Scholar
- 13.Gueorguiev B, Ockert B, Schwieger K, Wahnert D, Lawson-Smith M, Windolf M, Stoffel K (2011) Angular stability potentially permits fewer locking screws compared with conventional locking in intramedullary nailed distal tibia fractures: a biomechanical study. J Orthop Trauma 25(6):340–346. doi: 10.1097/BOT.0b013e3182163345 CrossRefPubMedGoogle Scholar
- 20.Mullis BH, Sagi HC (2008) 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? J Orthop Trauma 22(5):293–298. doi: 10.1097/BOT.0b013e31816b6b4e CrossRefPubMedGoogle Scholar
- 22.McLaren AC, Rorabeck CH, Halpenny J (1990) Long-term pain and disability in relation to residual deformity after displaced pelvic ring fractures. Can J Surg J Can Chir 33(6):492–494Google Scholar