Immediate percutaneous sacroiliac screw insertion for unstable pelvic fractures: is it safe enough?

  • A. Acker
  • Z. H. Perry
  • S. Blum
  • G. Shaked
  • A. Korngreen
Original Article



The purpose of this study was to compare the results of immediate and delayed percutaneous sacroiliac screws surgery for unstable pelvic fractures, regarding technical results and complication rate.


Retrospective study.


The study was conducted at the Soroka University Medical center, Beer Sheva, Israel, which is a level 1 trauma Center.


108 patients with unstable pelvic injuries were operated by the orthopedic department at the Soroka University Medical Center between the years 1999–2010. A retrospective analysis found 50 patients with immediate surgery and 58 patients with delayed surgery. Preoperative and postoperative imaging were analyzed and data was collected regarding complications.


All patients were operated on by using the same technique—percutaneous fixation of sacroiliac joint with cannulated screws.

Main outcome measurements

The study’s primary outcome measure was the safety and quality of the early operation in comparison with the late operation.


A total of 156 sacroiliac screws were inserted. No differences were found between the immediate and delayed treatment groups regarding technical outcome measures (P value = 0.44) and complication rate (P value = 0.42).


The current study demonstrated that immediate percutaneous sacroiliac screw insertion for unstable pelvic fractures produced equally good technical results, in comparison with the conventional delayed operation, without additional complications.


Pelvic fracture Sacroiliac screw Percutaneous Early vs. late insertion 


Compliance with ethical standards


No funding were received for the current study.

Conflict of interest

We Asaf Acker, Zvi Perry, Shlomo Blom, Gad Shaked and Amir Korngreen declare we have no conflict of interest.

Ethical standards statement

We hereby declare that all human and animal studies have been approved by the appropriate ethics committee and have therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.


  1. 1.
    Routt ML Jr, Nork SE, Mills WJ. High-energy pelvic ring disruptions. Orthop Clin North Am. 2002;33(1):59–72.CrossRefPubMedGoogle Scholar
  2. 2.
    Kregor PJ, Routt ML Jr. Unstable pelvic ring disruptions in unstable patients. Injury. 1999;30(Suppl 2):B19–28.CrossRefPubMedGoogle Scholar
  3. 3.
    Michael D. Stove., Keith A. May., James F. Kellam, . Pelvic Ring Disruptions. In: Bruce D. Browner editor. Skeletal Trauma. 4th ed, 3rd sect., chap. 36. Elsevier’s Health Sciences, Philadelphia; 2008.Google Scholar
  4. 4.
    Tile M. Acute pelvic fractures: II. Principles of management. J Am Acad Orthop Surg. 1996;4(3):152–61.CrossRefPubMedGoogle Scholar
  5. 5.
    Routt ML Jr, Nork SE, Mills WJ. Percutaneous fixation of pelvic ring disruptions. Clin Orthop. 2000;375:15–29.CrossRefGoogle Scholar
  6. 6.
    Routt M, Meier M, Kregor P. Percutaneous iliosacral screws with the patient supine technique. Oper Techn Orthop. 1993;3:35–45.CrossRefGoogle Scholar
  7. 7.
    Routt ML Jr, Simonian PT, Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma. 1997;8:584–9.CrossRefGoogle Scholar
  8. 8.
    Gardner MJ, Routt ML Jr. The antishock iliosacral screw. J Orthop Trauma. 2010;24:86–9.CrossRefGoogle Scholar
  9. 9.
    Tile M. Acute pelvic fractures: I. Causation and classification. J Am Acad Orthop Surg. 1996;4:143–51.CrossRefPubMedGoogle Scholar
  10. 10.
    Matta JM, Tornetta P. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res. 1996;329:129–40.CrossRefGoogle Scholar
  11. 11.
    Katsoulis Efstathios, Giannoudis PV. Impact of pelvic fixation on functional outcome. Injury. 2006;37:1133–42.CrossRefPubMedGoogle Scholar
  12. 12.
    Oliver CW, Twaddle J, et al. Outcome after pelvic ring fractures: evaluation using the medical outcomes short form SF-36. Injury. 1996;27:635–41.CrossRefPubMedGoogle Scholar
  13. 13.
    Pelvic ring fractures—early versus delayed fixation. Buckley Rick—Editor in chief. Orthopedic Trauma Directions 1/11, Vol 9, No 1, January 2011. Published by AO Foundation, Switzerland.Google Scholar
  14. 14.
    Routt ML Jr. Supine positioning for the placement of percutaneous sacral screws in complex posterior pelvic ring trauma. Orthop Trans. 1992;16:220.Google Scholar
  15. 15.
    Mataliotakis GI, Giannoudis PV. Radiological measurements for postoperative evaluation of quality of reduction of unstable pelvic ring fractures: advantages and limitations. Injury. 2011;42:1395–401.CrossRefPubMedGoogle Scholar
  16. 16.
    Tornetta P, Matta J. Outcome of operatively treated unstable posterior pelvic ring fractures. Clin Orthop Relat Res. 1996;329:186–93.CrossRefGoogle Scholar
  17. 17.
    Osterhoff G, Ossendorf C, et al. Posterior screw fixation in rotationally unstable pelvic ring injuries. Injury. 2011;42:992–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Schweitzer D, Zylberberb A, et al. Closed reduction and iliosacral percutaneous fixation of unstable pelvic ring fractures. Injury. 2008;39:869–74.CrossRefPubMedGoogle Scholar
  19. 19.
    Zamzam MM. Unstable pelvic ring injuries—outcome and timing of surgical treatment by internal fixation. Saudi Med J. 2004;25:1670–4.PubMedGoogle Scholar
  20. 20.
    Routt ML Jr, Kregor PJ, Simonian PT, et al. Early results of percutaneous iliosacral screws placed with the patient in the supine position. J Orthop Trauma. 1995;9:207–14.CrossRefPubMedGoogle Scholar
  21. 21.
    Shuler TE, Boone DC, Gruen GS, et al. Percutaneous iliosacral screw fixation: early treatment for unstable posterior pelvic ring disruptions. J Orthop Trauma. 1995;38:453–8.Google Scholar
  22. 22.
    Tonetti J, Carrat L, Lavallee S, et al. Percutaneous iliosacral screw placement using image guided techniques. Clin Orthop. 1998;354:103–10.CrossRefGoogle Scholar
  23. 23.
    Van den Bosch EW, Van Zwienen CM, Van Vugt AB. Fluoroscopic positioning of sacroiliac screw in 88 patients. J Trauma. 2002;53:44–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Plaisier BR, Meldon SW, Super DM, Malangoni MA. Improved outcome after early fixation of acetabular fractures. Injury. 2000;31(2):81–4.CrossRefPubMedGoogle Scholar
  25. 25.
    Connor GS, McGwin J Jr, MacLennan PA, et al. Early versus delayed fixation of pelvic ring fractures. Am Surg. 2003;69(12):1019–23.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Orthopedic DepartmentSoroka University Medical CenterBeer ShevaIsrael
  2. 2.Trauma UnitSoroka University Medical CenterBeer ShevaIsrael
  3. 3.Surgery Ward ASoroka University Medical CenterBeer ShevaIsrael
  4. 4.Epidemiology Department, Faculty of Health SciencesBen-Gurion UniversityBeer ShevaIsrael

Personalised recommendations