Type C pelvic ring injuries in polytrauma patients: can percutaneous iliosacral screws reduce morbidity and costs?

Forty-two polytrauma patients with pelvic injuries were included in this retrospective study to evaluate the benefits of percutaneous iliosacral screwing. All patients were followed up for at least 1 year, and their mean age was 39 years. According to Tile's classification, all cases were type C pelvic injuries. After primary anterior fixation, the iliosacral screws were applied percutaneously. Twenty-two cases had excellent reduction, 15 cases had good reduction, 4 cases had fair reduction and one case had poor reduction. The unsatisfactory final displacements were common among dislocations of the sacroiliac joints and operated cases during the second week. The final clinical outcome was satisfactory in 31 cases and unsatisfactory in 11 cases. Unsatisfactory clinical results were due to persistent posterior pelvic pain and limited activities in 7 cases and residual neurological disability in four cases. No posterior infection or iatrogenic nerve injuries were encountered; however, two cases had loosening of the applied improper screws. There was significant direct reduction in the hospital stay, transfused blood amount, ventilator time and complications when the percutaneous iliosacral screwing was carried out early during the first week. Therefore, indirect reduction in the hospital cost and polytraumatized patient morbidity was achieved.