Bilateral ilio-sacral screw fixation of sacroiliac joint using a single guidewire: a technical case report

Bilateral sacroiliac joint (SIJ) disruption is an uncommon, unstable pelvic injury with high morbidity. Percutaneous SI screw fixation is a well-established treatment but typically requires separate guidewire passes, increasing operative time and radiation exposure.

We report a 22-year-old male with bilateral pubic rami fractures and bilateral SIJ disruptions. After reduction and fixation of anterior ring, a single guidewire was passed from the left to the right SIJ, and bilateral screws were inserted over it under fluoroscopic guidance.

Bilateral fixation was successfully achieved with correct screw placement, effective compression, and intact L5 nerve function. This approach reduced operative time and fluoroscopic exposure.

Single-guidewire bilateral SIJ fixation is a simple, effective technique that decreases operative time and radiation exposure while ensuring safe, stable fixation. Careful fluoroscopic monitoring is essential, and the method is feasible in both obese and nonobese patients.