Percutaneous screw fixation for traumatic Tile C pelvic fractures - Does the number of screws matter? A review of clinical and biomechanical outcomes.

Abstract

This review addresses whether one-screw or two-screw percutaneous constructs offer superior outcomes for Tile C pelvic fractures. It compares biomechanical stability and clinical outcomes, weighing potential gains in stability against increased surgical complexity and complication risk. A systematic search of PubMed, Embase, and Web of Science identified clinical and biomechanical studies on posterior fixation in Tile C fractures. Inclusion criteria required adult traumatic injuries, percutaneous posterior screw fixation, and reported primary outcomes. Two reviewers independently screened and extracted data. Thirty biomechanical, six clinical, and one mixed-design study met inclusion criteria. One third of biomechanical studies favored the use of both a S1 and S2 screw for greater rigidity, while others showed benefit. Clinical studies showed mixed results, with some benefit for radiographic reduction and fixation failure in high-risk patterns but no consistent functional advantage. Significant heterogeneity in methodologies limited direct comparisons. Cumulative biomechanical evidence supports two-screw fixation for increased stability in Tile C fractures, especially unstable patterns. Clinical benefits remain uncertain, emphasizing individualized treatment decisions and the need for standardized future research.