Anterior sacroiliac dislocation

Although much has been written on the evaluation and management of pelvic ring injuries, only a single case of anterior sacroiliac joint dislocation exists in the literature and was reported in 1976. This article describes 2 additional cases, 1 of a pure anterior sacroiliac dislocation in a 25-year-old man, and 1 of an anterior sacroiliac fracture-dislocation in an 18-year-old man, each treated by a different orthopedic traumatologist at neighboring trauma centers. Both cases were the result of high-energy trauma, and both patients had significant complications resulting from severity of their injuries, including wound dehiscence and causalgia in 1 case and persistent L5-S1 paresthesias and paresis in the other. Closed reduction can be attempted, but in our experience was unsuccessful even with the use of external fixation pins for leverage. We recommend open reduction by an orthopedic traumatologist who will perform definitive fixation. The decision to use an anterior external fixation frame to assist during the patient's resuscitation should be based on the patient's hemodynamic status and concomitant injuries. Despite a high complication rate, operative intervention can return patients to a functional level with minimal residual pain.