The incidence of and factors affecting iliosacral screw loosening in pelvic ring injury

Joon Woo Kim, Chang Wug Oh, Jong-Keon Oh, Hee Soo Kyung, Kyeong Hyeon Park, Seong Dae Yoon, Sung Hyuk Yoon

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Introduction: Iliosacral screw fixation has been commonly used for stabilization of the posterior ring in unstable pelvic fractures. However, loosening of the screw may develop with or without redisplacement of the fracture. This study was undertaken to evaluate the incidence of iliosacral screw loosening and to identify its predictive factors. Materials and methods: In total, 110 patients whose posterior pelvic ring was stabilized with iliosacral screws were enrolled. These included 9 cases of anteroposterior compression, 64 cases of lateral compression, and 37 cases of vertical shear (VS) injuries. Among those with posterior pelvic ring injuries, 95 had sacral fractures (zone I: 52, zone II: 43) and 15 had sacroiliac joint dislocations. The screws were fixed to the anterior one-third region of the first sacral (S1) body in 46 cases, and to the middle one-third region in the remaining 64 cases. If loosening of the iliosacral screw influenced the pelvic ring stability, it was considered a failure. The relationship between iliosacral screw loosening and the possible influencing factors were analyzed. Results: Nineteen patients (17.3 %) were found to have loosening of the iliosacral screw at a mean 25.3 days postoperatively. Of these, 13 patients (11.8 %) had failure of the screws. The incidence of iliosacral screw loosening was significantly higher in those with VS injury (29.7 %, p = 0.014), in those with screw fixed to the middle one-third region of the S1 body (23.4 %, p = 0.044), and in those with VS injury combined with zone II sacral fracture (43.5 %, p = 0.019). With respect to failure of the iliosacral screw, patients with VS injury also had a higher incidence of failure (21.6 %, p = 0.036). Conclusions: Our findings demonstrate that cases with VS injuries are prone to screw loosening, especially when combined with zone II sacral fracture. Accordingly, alternative fixation methods should be considered in such cases.

Original languageEnglish
Pages (from-to)921-927
Number of pages7
JournalArchives of Orthopaedic and Trauma Surgery
Volume136
Issue number7
DOIs
Publication statusPublished - 2016 Jul 1

Fingerprint

Incidence
Wounds and Injuries
Sacrococcygeal Region
Sacroiliac Joint
Body Regions
Joint Dislocations

Keywords

  • Failure
  • Iliosacral screw
  • Loosening
  • Pelvic ring injury

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

The incidence of and factors affecting iliosacral screw loosening in pelvic ring injury. / Kim, Joon Woo; Oh, Chang Wug; Oh, Jong-Keon; Kyung, Hee Soo; Park, Kyeong Hyeon; Yoon, Seong Dae; Yoon, Sung Hyuk.

In: Archives of Orthopaedic and Trauma Surgery, Vol. 136, No. 7, 01.07.2016, p. 921-927.

Research output: Contribution to journalArticle

Kim, Joon Woo ; Oh, Chang Wug ; Oh, Jong-Keon ; Kyung, Hee Soo ; Park, Kyeong Hyeon ; Yoon, Seong Dae ; Yoon, Sung Hyuk. / The incidence of and factors affecting iliosacral screw loosening in pelvic ring injury. In: Archives of Orthopaedic and Trauma Surgery. 2016 ; Vol. 136, No. 7. pp. 921-927.
@article{a822affc2f1c4925bf0121e1832e3ea2,
title = "The incidence of and factors affecting iliosacral screw loosening in pelvic ring injury",
abstract = "Introduction: Iliosacral screw fixation has been commonly used for stabilization of the posterior ring in unstable pelvic fractures. However, loosening of the screw may develop with or without redisplacement of the fracture. This study was undertaken to evaluate the incidence of iliosacral screw loosening and to identify its predictive factors. Materials and methods: In total, 110 patients whose posterior pelvic ring was stabilized with iliosacral screws were enrolled. These included 9 cases of anteroposterior compression, 64 cases of lateral compression, and 37 cases of vertical shear (VS) injuries. Among those with posterior pelvic ring injuries, 95 had sacral fractures (zone I: 52, zone II: 43) and 15 had sacroiliac joint dislocations. The screws were fixed to the anterior one-third region of the first sacral (S1) body in 46 cases, and to the middle one-third region in the remaining 64 cases. If loosening of the iliosacral screw influenced the pelvic ring stability, it was considered a failure. The relationship between iliosacral screw loosening and the possible influencing factors were analyzed. Results: Nineteen patients (17.3 {\%}) were found to have loosening of the iliosacral screw at a mean 25.3 days postoperatively. Of these, 13 patients (11.8 {\%}) had failure of the screws. The incidence of iliosacral screw loosening was significantly higher in those with VS injury (29.7 {\%}, p = 0.014), in those with screw fixed to the middle one-third region of the S1 body (23.4 {\%}, p = 0.044), and in those with VS injury combined with zone II sacral fracture (43.5 {\%}, p = 0.019). With respect to failure of the iliosacral screw, patients with VS injury also had a higher incidence of failure (21.6 {\%}, p = 0.036). Conclusions: Our findings demonstrate that cases with VS injuries are prone to screw loosening, especially when combined with zone II sacral fracture. Accordingly, alternative fixation methods should be considered in such cases.",
keywords = "Failure, Iliosacral screw, Loosening, Pelvic ring injury",
author = "Kim, {Joon Woo} and Oh, {Chang Wug} and Jong-Keon Oh and Kyung, {Hee Soo} and Park, {Kyeong Hyeon} and Yoon, {Seong Dae} and Yoon, {Sung Hyuk}",
year = "2016",
month = "7",
day = "1",
doi = "10.1007/s00402-016-2471-3",
language = "English",
volume = "136",
pages = "921--927",
journal = "Archiv fur orthopadische und Unfall-Chirurgie",
issn = "0003-9330",
publisher = "J.F. Bergmann",
number = "7",

}

TY - JOUR

T1 - The incidence of and factors affecting iliosacral screw loosening in pelvic ring injury

AU - Kim, Joon Woo

AU - Oh, Chang Wug

AU - Oh, Jong-Keon

AU - Kyung, Hee Soo

AU - Park, Kyeong Hyeon

AU - Yoon, Seong Dae

AU - Yoon, Sung Hyuk

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Introduction: Iliosacral screw fixation has been commonly used for stabilization of the posterior ring in unstable pelvic fractures. However, loosening of the screw may develop with or without redisplacement of the fracture. This study was undertaken to evaluate the incidence of iliosacral screw loosening and to identify its predictive factors. Materials and methods: In total, 110 patients whose posterior pelvic ring was stabilized with iliosacral screws were enrolled. These included 9 cases of anteroposterior compression, 64 cases of lateral compression, and 37 cases of vertical shear (VS) injuries. Among those with posterior pelvic ring injuries, 95 had sacral fractures (zone I: 52, zone II: 43) and 15 had sacroiliac joint dislocations. The screws were fixed to the anterior one-third region of the first sacral (S1) body in 46 cases, and to the middle one-third region in the remaining 64 cases. If loosening of the iliosacral screw influenced the pelvic ring stability, it was considered a failure. The relationship between iliosacral screw loosening and the possible influencing factors were analyzed. Results: Nineteen patients (17.3 %) were found to have loosening of the iliosacral screw at a mean 25.3 days postoperatively. Of these, 13 patients (11.8 %) had failure of the screws. The incidence of iliosacral screw loosening was significantly higher in those with VS injury (29.7 %, p = 0.014), in those with screw fixed to the middle one-third region of the S1 body (23.4 %, p = 0.044), and in those with VS injury combined with zone II sacral fracture (43.5 %, p = 0.019). With respect to failure of the iliosacral screw, patients with VS injury also had a higher incidence of failure (21.6 %, p = 0.036). Conclusions: Our findings demonstrate that cases with VS injuries are prone to screw loosening, especially when combined with zone II sacral fracture. Accordingly, alternative fixation methods should be considered in such cases.

AB - Introduction: Iliosacral screw fixation has been commonly used for stabilization of the posterior ring in unstable pelvic fractures. However, loosening of the screw may develop with or without redisplacement of the fracture. This study was undertaken to evaluate the incidence of iliosacral screw loosening and to identify its predictive factors. Materials and methods: In total, 110 patients whose posterior pelvic ring was stabilized with iliosacral screws were enrolled. These included 9 cases of anteroposterior compression, 64 cases of lateral compression, and 37 cases of vertical shear (VS) injuries. Among those with posterior pelvic ring injuries, 95 had sacral fractures (zone I: 52, zone II: 43) and 15 had sacroiliac joint dislocations. The screws were fixed to the anterior one-third region of the first sacral (S1) body in 46 cases, and to the middle one-third region in the remaining 64 cases. If loosening of the iliosacral screw influenced the pelvic ring stability, it was considered a failure. The relationship between iliosacral screw loosening and the possible influencing factors were analyzed. Results: Nineteen patients (17.3 %) were found to have loosening of the iliosacral screw at a mean 25.3 days postoperatively. Of these, 13 patients (11.8 %) had failure of the screws. The incidence of iliosacral screw loosening was significantly higher in those with VS injury (29.7 %, p = 0.014), in those with screw fixed to the middle one-third region of the S1 body (23.4 %, p = 0.044), and in those with VS injury combined with zone II sacral fracture (43.5 %, p = 0.019). With respect to failure of the iliosacral screw, patients with VS injury also had a higher incidence of failure (21.6 %, p = 0.036). Conclusions: Our findings demonstrate that cases with VS injuries are prone to screw loosening, especially when combined with zone II sacral fracture. Accordingly, alternative fixation methods should be considered in such cases.

KW - Failure

KW - Iliosacral screw

KW - Loosening

KW - Pelvic ring injury

UR - http://www.scopus.com/inward/record.url?scp=84966700373&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84966700373&partnerID=8YFLogxK

U2 - 10.1007/s00402-016-2471-3

DO - 10.1007/s00402-016-2471-3

M3 - Article

C2 - 27168134

AN - SCOPUS:84966700373

VL - 136

SP - 921

EP - 927

JO - Archiv fur orthopadische und Unfall-Chirurgie

JF - Archiv fur orthopadische und Unfall-Chirurgie

SN - 0003-9330

IS - 7

ER -