International Orthopaedics

, Volume 43, Issue 10, pp 2399–2404 | Cite as

Occult injuries of the contralateral sacroiliac joint in operatively treated pelvis fractures: incidence, root cause analysis, and proposal of treatment algorithm

  • Andrew S. Maertens
  • Murphy P. MartinIII
  • Chase S. Dean
  • David Rojas
  • Joshua A. Parry
  • Michael Maher
  • Cyril P. MauffreyEmail author
Original Paper



To determine the most common injury patterns, root cause, and the frequency with which unrecognized contralateral posterior ring injury occurs in patients presenting with surgically treated pelvic fractures.


The medical records of 73 patients presenting to our level I trauma center (52 male and 21 female patients; mean age 41.8 years; range 18–89 years) with surgically treated pelvic ring fractures between January 1, 2016 and January 1, 2018 were reviewed. Patient demographics, mechanism of injury, associated injuries, imaging prior to binder or external fixation, use of temporary stabilization with pre-peritoneal pelvic packing (PPP) and anterior pelvic external fixation, and fracture pattern were recorded and analyzed to identify independent risk factors contributing to occult contralateral missed posterior ring injury.


Occult contralateral pelvic ring injuries occurred in 6/72 patients (8.2% incidence). Pelvis fractures in multiply traumatized patients with associated orthopaedic injuries were associated with higher prevalence of occult contralateral pelvic ring injury (relative risk 1.85, 95% CI 1.13–3.02) as compared to patients with isolated pelvic fractures.


There is an 8.2% incidence of unrecognized contralateral SI joint instability in patients presenting with unstable pelvic ring injuries. Multiply traumatized patients with multiple orthopaedic injuries were an independent risk factor for this injury pattern.


Occult pelvis fracture Pelvic ring fracture Missed pelvic injury Contralateral injury SI dislocation Pelvic binder EUA External fixation of pelvis 



The authors acknowledge Dr. Angela Sauaia, MD, PhD, for performing the statistical analyses.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Andrew S. Maertens
    • 1
  • Murphy P. MartinIII
    • 2
  • Chase S. Dean
    • 1
  • David Rojas
    • 1
  • Joshua A. Parry
    • 1
  • Michael Maher
    • 1
  • Cyril P. Mauffrey
    • 1
    Email author
  1. 1.Department of OrthopaedicsDenver Health Medical CenterDenverUSA
  2. 2.Department of Orthopedic SurgeryTulane University School of MedicineNew OrleansUSA

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