Posterior hinge fixation for the treatment of unstable traumatic sacroiliac joint injuries

Introduction: Posterior hinge fixation (PHF) is a sacroiliac joint fixation method indicated for the surgical treatment of unstable pelvic ring fractures (tile C). Hypothesis: PHF yields good functional outcomes based on the Majeed score at more than 1 year of follow-up. Methods: A single-center, retrospective study of patients who had a Tile C pelvic ring fracture, who were operated by PHF and who were evaluated at a minimum follow-up of 1 year. The functional outcome was determined using the Majeed score and pain was evaluated by the patients using a visual analog scale (VAS). The preoperative, intraoperative and postoperative data, complications and sequelae were documented. A CT-scan was done at least 1 year after the surgical treatment to determine the SI joint's reduction and fusion. Results: Included were 22 patients (59% men) who had a mean age of 37.3 +/- 11.9 years; 21 of these patients were reviewed at a mean of 4.8 +/- 4 years. The mean Majeed score at the final assessment was 76.4 points +/- 15.3, with 24% of patients having excellent results (n = 5), 53% having good results (n = 11), 19% having average results (n = 4) and 5% having poor results (n = 1). The mean pain level on VAS was 28 +/- 23 mm. Of the eight surgical site infections, seven occurred in the PHF (88%). CT-scans taken at 1 year postoperative were compared to the preoperative scans. The pelvic opening was reduced by -9 +/- 6 (p < 0.01), SI diastasis by -11 mm +/- 9 (p < 0.001), vertical displacement by-7 mm +/- 8 (p < 0.001), symphysis opening by -15 mm +/- 15 (p < 0.001), median transverse diameter by -10 mm +/- 9 (p < 0.001) and bispinal diameter by -5 mm +/- 7 (p < 0.001). SI fusion was confirmed in 43% of patients (n = 9). Conclusion: PHF is a surgical instrumentation method that provides satisfactory long-term reduction of Tile C pelvic ring fractures. The clinical outcomes are good or excellent in 77% of cases. The perioperative morbidity is marked by surgical site infections, all of which healed. Level of evidence: IV; retrospective, non-comparative cohort study. (C) 2022 Elsevier Masson SAS. All rights reserved.

Automated summary

Posterior hinge fixation (PHF) is a surgical method for treating unstable pelvic ring fractures (Tile C), which has shown good functional outcomes and pain control. Follow-up of more than 1 year revealed that 77% of patients achieved good or excellent clinical results, with surgical site infection being the main complication.