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Vertical shear pelvic ring injuries: do transsacral screws prevent fixation failure?
Breann K Tisano1, Drew P Kelly2, Adam J Starr1
1Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Summary
Transsacral-transiliac (TS) screw fixation of vertical shear pelvic injuries has a high failure rate, particularly with single screws in sacral fractures. Surgeons should avoid relying on single TS screws for these unstable injuries.
Area of Science:
- Orthopedic surgery
- Trauma surgery
- Pelvic fracture management
Background:
- Vertical shear (VS) pelvic ring injuries (OTA/AO 61C1) are complex fractures requiring stable fixation.
- Transsacral-transiliac (TS) screws are utilized for posterior pelvic fixation.
Purpose of the Study:
- To determine the frequency of fixation failure after TS screw fixation for VS pelvic ring injuries.
- To describe the failure mechanisms of TS screws in this patient population.
Main Methods:
- Retrospective cohort study of 20 patients with unilateral, displaced VS pelvic injuries treated with TS screws.
- Radiographic failure defined as >1 cm displacement on inlet/outlet views.
- Follow-up averaged 14 months.
Main Results:
- Fixation failure occurred in 50% (4/8) of vertical sacral fractures.
- The dominant failure mechanism was screw bending, often with single TS screw fixation.
- No failures were observed in sacroiliac dislocations; no infections or nonunions reported.
Conclusions:
- Single TS screw fixation is unreliable for vertically unstable sacral fractures.
- Surgeons should exercise caution and consider alternative fixation methods.
- Close early postoperative radiographic monitoring is recommended.
