Single trans-iliac trans-sacral screw (STITSS) versus dual iliosacral screws (ISS) in fixation of unstable pelvic ring disruptions.

Abstract

To compare between single trans-iliac trans-sacral screw versus dual ilio-sacral screws in Management of unstable pelvic ring disruptions after achieving reduction, to facilitate union of the fracture and early mobilization. In a retrospective cohort study that was done in Assiut University hospital trauma unit between May 2018 to September 2020, 36 patients with unstable fracture pelvis were included in the study. Single trans-iliac trans-sacral screws were done in 16 cases while two ilio-sacral screws were done for the rest of cases. Age ranged from 18 to 57 years old, with exclusion of patients with spino-pelvic dissociation, comminuted fractures, chronic uncontrolled co-morbidities, bilateral sacral fractures. Follow up of the patients radiologically using plain X-ray and Computed Tomography scan to identify union of fractures were reported. Functional follow-up using Majeed score and Visual analogue scale were reported with allowance of weight bearing as tolerated. The two groups were comparable in terms of baseline characteristics, including age, sex, and comorbidities. A significant difference was observed in Tile classification between the groups (P = 0.05), while there was no significant difference in Denis classification (P = 0.29). Operative parameters such as surgical time, fluoroscopy time, and blood loss were similar between the two groups (P > 0.05). Outcome analysis revealed that patients in the STITSS group experienced significantly less pain at six weeks post-surgery, with lower VAS scores (4.31 ± 0.87 vs. 6.38 ± 1.31; P = 0.000). However, by 3 and 6 months, the VAS scores showed no significant differences between the groups (P > 0.05). Additionally, functional outcomes measured by the Majeed score were significantly better in the STITSS group at six weeks (61.64 ± 8.55 vs. 53.15 ± 7.80; P = 0.037). Similar to pain scores, the Majeed scores equalized between the groups at 3 and 6 months, with no significant differences noted. The study findings indicate that STITSS fixation offers better early outcomes in terms of pain relief and functional recovery compared to dual ilio-sacral screw fixation. Despite the technical challenges associated with STITSS, it allows for faster rehabilitation and a quicker return to functional activities. In the long term, however, both techniques demonstrate comparable results. Further research is needed to validate these findings and optimize fixation strategies for unstable pelvic fractures.