Diagnostic accuracy of MRI for detection of occult instability of type I anterior to posterior pelvic injuries.

Type I Young and Burgess anterior posterior compression (APC) pelvic injuries have been classically managed non operatively due to theoretical integrity of sacroiliac joint ligaments (SIJL), though examination under anesthesia (EUA) has been proven occult mechanical instability in up to 50% of these injuries.  We sought to determine the diagnostic accuracy of magnetic resonance (MRI) for detection of occult instability on APC-I injuries when compared to EUA. METHODS: Diagnostic test study of prospectively recruited patients admitted with APC-I pelvic injuries between 2015 and 2022. All patients consented to participate in this study were subjected to MRI and EUA. The evaluators of each of these tests were blinded.  On MRI evaluation, SIJL were considered compromised when unilateral injury to anterior SIJL was visualized in three or more consecutive images or in bilateral injuries, when injury to the anterior SIJL in two or more consecutive images on each side was observed. Positive EUA was considered a symphyseal diastasis over 25 mm on stress fluoroscopy. Demographic data was collected as recruited and sensitivity, specificity, accuracy, and positive and negative predictive values were calculated. Confidence interval was set at 95%. EUA was considered the gold standard in statistical analysis. RESULTS: A total of 32 patients mean aged 36 (24-61) years were included. Mean symphyseal diastasis at admission was 17.58 (11 - 25) mm. The median time from injury to EUA was 5 (0-21) days. Positive EUA was observed on 20 patients and 25 patients  presented compromised SIJL. MRI presented a sensitivity of 95% (75.13% - 99.87%), specificity of 50% (21.09% - 78.91%), positive-predictive value of 73% (60.61% to 82.93%), negative-predictive value of 87% (48.66% - 98.08%). CONCLUSION: Injury to SIJL on MRI presented an accuracy of 77% (58.29% - 89.64%) for the detection of occult pelvic instability on EUA.

Sacroiliac joint dysfunction and lumbar pain. Evaluation in a Brazilian population.

The study intended to evaluate the incidence and evolution of sacroiliac joint dysfunction (SIJD). To reach 50 patients with SIJD diagnosis, 192 patients with low back pain and failure in conservative approach were consecutively examined (26% incidence). Initially patients underwent intra-articular (IA) corticosteroid sacroiliac joint (SIJ) block followed, if necessary, by cooled SIJ radiofrequency or referred to surgical intervention, in order of complexity. From the 50 patients submitted to IA SI block, 41 (82%) referred pain and quality of life improvement and lesser rescue analgesics consumption for 25 weeks. The block induced a prompt onset of pain relief and there was a drop in mean pain score from 8 to 2 cm (p < 0.001) maintained up to 25 weeks. Rescue analgesic consumption also significantly dropped (p < 0.05). However, nine patients (18%) did not refer long lasting improvement in the third week evaluation and underwent cooled radiofrequency. From this population of nine, seven were successful (78%) while two were recommended surgery. In view of the 50 patients, 82% were comfortable after IA block, 18% were submitted to radiofrequency, with a success rate of 78%. The final incidence of surgery suggestion was 4%.

El estudio pretende evaluar la incidencia y evolución de la disfunción de la articulación sacroilíaca (DASI). Para llegar a 50 pacientes con diagnóstico de DASI, se examinaron consecutivamente 192 pacientes con dolor lumbar y fracaso en el abordaje conservador (26% de incidencia). Inicialmente, los pacientes se sometieron a un bloqueo de la articulación sacroilíaca (ASI) con corticosteroides intraarticulares (IA) seguido, si era necesario, de radiofrecuencia ASI enfriada o remitidos a una intervención quirúrgica, en orden de complejidad. De los 50 pacientes sometidos al bloqueo IA SI, 41 (82%) refirieron mejoría del dolor y de la calidad de vida y menor consumo de analgésicos de rescate durante 25 semanas. El bloqueo indujo un rápido inicio del alivio del dolor y hubo una caída en la puntuación media del dolor de 8 a 2 cm (p < 0.001) mantenida hasta 25 semanas. El consumo de analgésicos de rescate también disminuyó significativamente (p < 0.05). Sin embargo, nueve pacientes (18%) no refirieron una mejoría duradera en la evaluación de la tercera semana y se sometieron a radiofrecuencia fría. De esta población de nueve, siete tuvieron éxito (78%), mientras que a dos se les recomendó cirugía. De los 50 pacientes, 82% se sintió cómodo después del bloqueo IA, 18% fue sometido a radiofrecuencia, con una tasa de éxito de 78%. La incidencia final de sugerencia de cirugía fue de 4%.

Transfixation of the Sacroiliac Joint: Biomechanical Stability of a Dual-Implant Minimally Invasive Procedure.

BACKGROUND: Despite minimally invasive techniques for sacroiliac joint fixation, clinical challenges remain. The investigators hypothesized the studied technique will transfix the sacroiliac joint to a level comparable to the intact sacroiliac joint. OBJECTIVES: The study objective was to determine the dynamic stability of a square inter-joint implant using a triangular notch in opposing bone segments spanning the joint space. STUDY DESIGN: Stability was assessed by measuring micromotion using contralaterally placed transducers spanning the sacroiliac joint of a specimen during cyclic loading. SETTING: A porcine in-vitro model was equipped with micromotion transducers on the intact and surgically implanted sacroiliac joint. Cyclic loading was applied on the L4 vertebra and the recorded micromotion data at each sacroiliac joint was analyzed. METHODS: Porcine specimens from L3 to the sacrum including the pelvic ring were used to biomechanically evaluate the implantation technique. A novel technique consisting of a square inter-joint implant was placed so as to create a triangular stabilization notch within adjacent boney components of the sacroiliac joint. Displacement transducers were placed across implanted and contralateral porcine sacroiliac joint. Specimens were subjected to compressive loading between -10N and -100N followed by bending/rotation between 0.4Nm and 4.0Nm. Tests were conducted at 0.5Hz for 200 cycles. For each loading mode, transducer deflections (or rotations) were averaged at five-cycle intervals. Student's t-tests were used to compare fitted parameters between implanted and intact sacroiliac joint. RESULTS: In compression, implanted SIJ displayed reduced deflection compared to intact sacroiliac joint (P < 0.0001). In bending/rotation, initial rotation for the intact sacroiliac joint was increased compared to implanted sacroiliac joint (P < 0.0001). The computed Half-Life parameter represents the number of cycles at which the initial rotation decreases by 50% and was found to be statistically reduced for implanted sacroiliac joint as compared to intact sacroiliac joint. LIMITATIONS: The use of porcine specimens resulted in uniform and good quality bone purchase. Further study may be required to evaluate the technique in older patients where bone quality is reduced. CONCLUSIONS: Compared to the intact sacroiliac joint, the implant and procedure in this study demonstrated decreased motion under cyclic compression. Under rotation, the implanted sacroiliac joint displayed increased initial stability that subsequently normalized to intact sacroiliac joint values.

Ligaments stabilizing the sacrum and sacroiliac joint: a comprehensive review.

The sacroiliac joint is a diarthrodial synovial joint in the pelvis. Anatomically, it is described as a symphysis, its synovial joint characteristics being limited to the distal cartilaginous portion on the iliac side. It is a continuous ligamentous stocking comprising interconnecting ligamentous structures and surrounding fascia. Its ligaments, the primary source of its stability, include the anterior, interosseous and dorsal sacroiliac, the iliolumbar, sacrotuberous, and sacrospinous. Structural reinforcement is also provided by neighboring fascia and muscles. Lower back pain is a common presentation of sacroiliac joint disease, the best-established treatments being corticosteroid injections, bipolar radiofrequency ablation, and sacroiliac joint fusion.

Retrospective Study of the Analgesic Effect of Sacroiliac Joint Radiofrequency Denervation.

BACKGROUND: Interventional radiofrequency (RF) ablation techniques are indicated when an adequate effect is not obtained with conservative measures. OBJECTIVES: The primary objective of this study was to evaluate pain relief after RF denervation of the sacroiliac joint. The secondary objective was to evaluate pain intensity and relief duration. STUDY DESIGN: The study was retrospective. SETTING: The study was conducted at Vera Cruz Hospital, Campinas, Brazil. METHODS: Data were collected from the medical records of patients undergoing RF denervation for low back pain originating in the sacroiliac joint, from January 2015 to December 2017. There were 78 patients studied, between 18 and 65 years old, of both genders, ASA I or II, who underwent knee arthroscopic meniscectomy. The patients were submitted to denervation of sacroiliac joint by 3 types of RF (conventional, pulsed, and cooled). The following parameters were evaluated, number of patients who obtained ? 50% pain relief; pain intensity, measured using the visual analog scale (before the procedure and 15, 30, 90 and 180 days after, performed by the same evaluator); and the use of complementary analgesic for 2 weeks. RESULTS: Of the 78 included patients, 56 (71.8%) underwent conventional RF, 9 (11.5%) underwent pulsed RF, and 13 (16.7%) underwent cooled RF. There were losses to follow-up including 40 patients who underwent conventional RF, 5 who underwent pulsed RF, and 12 who underwent cooled RF, who were retained for 6 months. There was significant pain relief with the three types of RF for up to 6 months of follow-up, with no difference among the types. After 6 months, 90.2% of patients who underwent conventional RF, 100% who underwent pulsed RF, and 91.7% who underwent cooled RF maintained ≥ 50% pain relief. Complementary analgesics were used by 95% of the patients who underwent conventional RF, 80% who underwent pulsed RF, and 91% who underwent cooled RF 2 weeks after the procedure. There were mild adverse effects, such as edema, hematoma, and local pain, without complications. LIMITATIONS: As for limitations, the number of pulsed and cooled RF is low and in a retrospective study some data may be missing, especially from follow-up. CONCLUSIONS: RF denervation of the sacroiliac joint is effective and promotes a long-lasting analgesic effect.

Acetabular ventroversion using the sacroiliac wedge, with or without pelvic osteotomies in dogs: an ex vivo study / Ventroversão acetabular associada ou não a osteotomias pélvicas por meio da utilização de cunha sacroilíaca em cães: estudo ex-vivo

Canine hip dysplasia (CHD) is a common condition observed in the surgical clinics for small animals. Among the surgical techniques for management of CHD, triple pelvic osteotomy and sacroiliac wedge promote acetabular lateral axial rotation (ventroversion), increasing acetabular coverage and joint stability. The present study aimed to evaluate radiographically, by measuring the Norberg angle (NA) and the acetabular coverage percentage (ACP), the acetabular ventroversion induced by the sacroiliac wedge technique, with or without pelvic osteotomies; we also checked the feasibility of wedges made of polyamide with an angulation of 20° and 30°. The software used to measure NA and ACP was AutoCAD® 2009. Pelves from 10 canine corpses were evaluated radiographically at four time-points: M0 (Control Group), M1 (wedges of 20° and 30°), M2 and M3 (wedges associated with bilateral pubis and ischium osteotomies, respectively). There was no significant increase in the acetabular ventroversion at M1, M2, and M3. The polyamide sacroiliac wedge technique proved to be feasible, stable, and easy to apply. Further, the software proved to be efficient and easy to use for NA and ACP measurements. In the present study, even in the cases of non-dysplasic adult canine corpses, it was concluded that the sacroiliac wedge technique does not require to be accompanied by pubis and ischial osteotomies because they did not significantly increase the NA and ACP.(AU)

A displasia coxofemoral (DCF) é afecção comum na clínica cirúrgica de pequenos animais. Entre as técnicas cirúrgicas para controle da DCF, a osteotomia pélvica tripla (OPT) e a cunha sacroilíaca (CSI), promovem rotação lateral acetabular no eixo axial (ventroversão), aumentando a cobertura acetabular e a estabilidade da articulação. Desta forma, o presente estudo objetivou avaliar radiograficamente, por meio da aferição do ângulo de Norberg (NA) e da porcentagem de cobertura acetabular (PCA), a ventroversão acetabular induzida pela técnica da cunha sacroilíaca, associada ou não às osteotomias pélvicas, além de verificar a exequibilidade das cunhas confeccionadas de poliamida com angulação de 20ο e 30ο. O software utilizado para aferir o AN e o PCA foi o AutoCAD® 2009. Dez pelves de cadáveres caninos foram avaliadas radiograficamente em quatro momentos: MO (Grupo Controle), M1 (cunhas de 20ο e 30ο), M2 e M3 (cunhas associadas à osteotomia bilateral do púbis e ísquio, respectivamente). Não houve aumento significativo da ventroversão em M1, M2 e M3. A técnica de cunha sacroilíaca de poliamida mostrou-se exequível, estável e de fácil aplicação. Não obstante, o software utilizado mostrou-se eficiente e de fácil utilização nas aferições do AN e PCA. Neste estudo, mesmo tratando-se de cadáveres de cães adultos e de maioria não displásicos, concluiu-se que a utilização da técnica de cunha sacroilíaca não necessita de associação à ostectomia púbica e a osteotomia do ísquio por não promoverem aumento significativo do AN e da PCA.(AU)

Acetabular ventroversion using the sacroiliac wedge, with or without pelvic osteotomies in dogs: an ex vivo study / Ventroversão acetabular associada ou não a osteotomias pélvicas por meio da utilização de cunha sacroilíaca em cães: estudo ex-vivo

Canine hip dysplasia (CHD) is a common condition observed in the surgical clinics for small animals. Among the surgical techniques for management of CHD, triple pelvic osteotomy and sacroiliac wedge promote acetabular lateral axial rotation (ventroversion), increasing acetabular coverage and joint stability. The present study aimed to evaluate radiographically, by measuring the Norberg angle (NA) and the acetabular coverage percentage (ACP), the acetabular ventroversion induced by the sacroiliac wedge technique, with or without pelvic osteotomies; we also checked the feasibility of wedges made of polyamide with an angulation of 20° and 30°. The software used to measure NA and ACP was AutoCAD® 2009. Pelves from 10 canine corpses were evaluated radiographically at four time-points: M0 (Control Group), M1 (wedges of 20° and 30°), M2 and M3 (wedges associated with bilateral pubis and ischium osteotomies, respectively). There was no significant increase in the acetabular ventroversion at M1, M2, and M3. The polyamide sacroiliac wedge technique proved to be feasible, stable, and easy to apply. Further, the software proved to be efficient and easy to use for NA and ACP measurements. In the present study, even in the cases of non-dysplasic adult canine corpses, it was concluded that the sacroiliac wedge technique does not require to be accompanied by pubis and ischial osteotomies because they did not significantly increase the NA and ACP.(AU)

A displasia coxofemoral (DCF) é afecção comum na clínica cirúrgica de pequenos animais. Entre as técnicas cirúrgicas para controle da DCF, a osteotomia pélvica tripla (OPT) e a cunha sacroilíaca (CSI), promovem rotação lateral acetabular no eixo axial (ventroversão), aumentando a cobertura acetabular e a estabilidade da articulação. Desta forma, o presente estudo objetivou avaliar radiograficamente, por meio da aferição do ângulo de Norberg (NA) e da porcentagem de cobertura acetabular (PCA), a ventroversão acetabular induzida pela técnica da cunha sacroilíaca, associada ou não às osteotomias pélvicas, além de verificar a exequibilidade das cunhas confeccionadas de poliamida com angulação de 20ο e 30ο. O software utilizado para aferir o AN e o PCA foi o AutoCAD® 2009. Dez pelves de cadáveres caninos foram avaliadas radiograficamente em quatro momentos: MO (Grupo Controle), M1 (cunhas de 20ο e 30ο), M2 e M3 (cunhas associadas à osteotomia bilateral do púbis e ísquio, respectivamente). Não houve aumento significativo da ventroversão em M1, M2 e M3. A técnica de cunha sacroilíaca de poliamida mostrou-se exequível, estável e de fácil aplicação. Não obstante, o software utilizado mostrou-se eficiente e de fácil utilização nas aferições do AN e PCA. Neste estudo, mesmo tratando-se de cadáveres de cães adultos e de maioria não displásicos, concluiu-se que a utilização da técnica de cunha sacroilíaca não necessita de associação à ostectomia púbica e a osteotomia do ísquio por não promoverem aumento significativo do AN e da PCA.(AU)

Sacroiliac Joint Fusion Methodology - Minimally Invasive Compared to Screw-Type Surgeries: A Systematic Review and Meta-Analysis.

BACKGROUND: Sacroiliac (SI) joint fusion represents a unique area of orthopedic surgery with procedural literature dating to the early 1920s, showing limited innovation in either technique or hardware over the last 90 years. Recent improvements in the diagnosis and treatment of SI joint dysfunction warrant comparisons to older surgical techniques. OBJECTIVE: To evaluate treatment efficacies and patient outcomes associated with minimally invasive joint fusion in comparison to screw-type surgeries. STUDY DESIGN: Systematic review and meta-analysis. SETTING: Electronic databases, EMBASE, Pubmed (Medline), manual bibliography cross-referencing for published works until Dec. 31, 2017. METHODS: A thorough literature search was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Data repositories accessed included Pubmed and EMBASE, until Dec. 31, 2017. All studies evaluating sacroiliac joint fusion and reporting quantifiable outcome data were included. Exclusion criteria included nonhuman studies, qualitative reviews, and meta-analyses. Data compilation, coding, and extraction were performed using MedAware Systems proprietary software. Data from each study were extracted by 2 analysts, using software that allowed automatic comparisons of all data fields. The standardized mean difference (SMD) was used as a summary statistic for pooling outcomes data across studies. Multiple outcome measures were grouped into 3 categories, according to similarity of measurements - Pain, Disability/Physical Function, and Global/QOL. RESULTS: A total of 20 studies had adequate data to calculate a SMD, and were included in the meta-analysis. Results of iFuse trials were compared to screw type trials, pooled in 3 categories of outcomes - Pain, Disability/Physical Function, and Global/QOL. The Pain category showed a statistically significant (P = 0.03) difference in outcomes for patients receiving the iFuse implant compared to screw types (SMD = 2.04 [95%CI: 1.76 to 2.33] vs. 1.28 [95%CI: 0.47 to 2.09]), with iFuse showing significantly better outcomes. The Disability category also showed a statistically significant (P = 0.01) difference in outcomes for patients receiving the iFuse implant compared to screw types (SMD = 1.68 [95%CI: 1.43 to 1.94] vs. 0.26 [95%CI: -1.90 to 2.41]), with iFuse showing significantly better outcomes. For Global/Quality of Life (QOL) outcomes, there was a significant difference (P = 0.04) between iFuse and screw-type procedures (SMD = 0.99 [95%CI: 0.75 to 1.24] vs. 0.60 [95%CI: 0.33 to 0.88]), with iFuse showing significantly better outcomes. There was a statistically significant correlation between lower baseline Oswestry Disability Index (ODI) and Short Form 36 Health Survey (SF-36) values and better post treatment outcomes (r2 = 0.47, P < 0.01, and r2 = 0.30, P < 0.01, respectively). An association was found between pain at baseline and better outcomes (r2 = 0.21, P < 0.01), where worse baseline pain was associated with better outcomes. LIMITATIONS: There was a limited number of studies in this meta-analysis with treatments that could be properly classified as screw-type. CONCLUSION: In this analysis, compared to screw-type surgeries, the iFuse system showed statistically superior outcomes. This was the case when outcome measures were classified into 3 main categories - Pain, Disability/Physical Function, and Global/QOL. KEY WORDS: Meta-analysis, systematic review, sacroiliac joint, sacroiliac joint fusion.

Percutaneous Sacroiliac Screw Technique.

Remembering that preoperative planning, surgical indications, and fracture reduction are paramount for this procedure, presented here is our technique for performing percutaneous sacroiliac screws, both transiliac-transsacral and sacral style. A combination of video, still pictures, and fluoroscopy images will guide the viewer through the process we routinely use highlighting specific details. Patient positioning and intraoperative fluoroscopy imaging are critical to a successful procedure. Although inlet and outlet films remain important, we find the procedure best started on the lateral sacral view to reduce the need for start site, trajectory, and imaging position changes during the case. A cannulated pig sticker (drill guide) used with long drill tip guide wires provide improved manual control to both finding a good start site and directing the trajectory. For patient safety, sacral anatomy and safe zones are discussed as well. Using these technical points will help make this a successful procedure.

Denervación de la articulación sacroilíaca por radiofrecuencia: una descripción de las técnicas disponibles / Sacroiliac joint denervation radiofrequency: an overview of available techniques

La articulación sacroilíaca es una fuente de dolor lumbar y dolor referido en la extremidad inferior. Aún no existen rasgos históricos, clínicos o radiológicos definitivos para hacer un diagnóstico preciso del dolor originado en la articulación sacroilíaca. La inervación de esta articulación continúa siendo objeto de debate y en la literatura se describen muchos abordajes diferentes. Los bloqueos diagnósticos son la herramienta diagnóstica más precisa pues la reducción del dolor confirma el rol de la articulación sacroilíaca como generadora del mismo. En muchos pacientes, cuando la reducción del dolor se logra luego de bloqueos intraarticulares únicos o consecutivos, se realiza una denervación por radiofrecuencia, con el objetivo de obtener una analgesia de larga duración. El propósito de este artículo es describir las técnicas disponibles actualmente para la denervación por radiofrecuencia.

The sacroiliac joint is a source of low back pain and referred pain in the lower extremity. There are still no definite historical, clinical or radiological features to make a precise diagnosis of pain originating from the sacroiliac joint. The innervation of the sacroiliac joint remains a subject of much debate and different approaches are described in the literature. Diagnostic blockades are the most accurate diagnostic tool, since pain reduction confirms the role of sacroiliac joint as a generator of it. In many patients, when pain reduction is achieved after single or consecutive intra-articular blockades, a radiofrequency denervation is performed for the purpose of obtaining a long term analgesia. The purpose of this paper is to describe the techniques currently available for radiofrequency denervation.

Closed reduction and iliosacral percutaneous fixation of unstable pelvic ring fractures.

OBJECTIVE: To report clinical results of patients treated with closed reduction and percutaneous iliosacral screw fixation for unstable pelvic ring fractures. MATERIALS AND METHODS: Retrospective study using medical records, images and late clinical assessment of all patients treated in our centre with percutaneous iliosacral screw fixation for unstable pelvic ring fractures, with a minimum follow-up of 12 months. Seventy-three patients with a mean age of 40.3 years old (range 14-70 years) were treated between July 1998 and December 2005. Seventy-one patients were included. Fractures types included 10 AO type B and 61 AO type C injuries. Forty-two patients had associated injuries. Mean follow-up was 31 months (12-96). Functional status was assessed using Majeed's grading score for pelvic fractures at final follow-up. RESULTS: Sixty-nine patients obtained a satisfactory initial reduction. Two patients had transitory postoperative neurological deficit. Five patients presented hardware failure. Fifteen patients developed sacroiliac osteoarthritis during follow-up. Good and excellent functional results were observed in 66 patients at final follow-up. Five patients had bad results, one due to infection of an anterior pelvic plate and the others due to painful refractory sacroiliac osteoarthritis that required a sacroiliac fusion. Sixty-one (86%) patients were able to return to pre-injury occupation. CONCLUSIONS: Good clinical results with a low and predictable rate of complications can be expected using closed reduction and percutaneous iliosacral screw fixation for unstable pelvic ring fractures.

Artrodesis sacroiliaca en secuelas post-traumáticas de fractura de pelvis inestable / Sacroiliac arthrodesis in post traumatic sequela of unstable pelvic fractures

Post-traumatic sacroiliac joint osteoarthritis and pseudarthrosis are rare. They generally appear as a complication of unstable pelvic fracture. The goal of this study is to describe the functional and radiographic outcome of sacroiliac joint arthrodesis (SJA) in post-traumatic sequela of unstable pelvic fractures. We perform a retrospective review of patients who underwent sacroiliac joint arthrodesis between 1984 and 2005 at the Hospital del Trabajador de Santiago with a minimum of 1 year follow up. From a total of 235 patients with the diagnosis of unstable pelvic fracture within this period, 11 presented chronic sacroiliac pain refractary to conservative treatment that required SJA. There were 9 men and 2 women with an average age of 42 years old (range 24-58). At the time of SJA, 7 patients had post-traumatic osteoarthritis and 4 posttraumatic pseudarthrosis. Time between the accident and SJA was 15.8 months in average (range 6-55). The SJA was performed using a posterior sacroiliac approach followed by curettage of the articular cartilage and bone grafting. The joint is then stabilized with the use of screws and/or plate except in 1 patient. All the patients were evaluated radiographically in the postoperative period. Functional outcome was evaluated using Majeed`s grading score. The mean follow up was 8 years (with a minimum of 1 year). Nine of the11 patients achieved solid fusion. Five of 11 had excellent and good functional results and 6 of 11 had fair or poor. The SJA is thought to be the last procedure in posttraumatic disorders of the sacroiliac joint. In this group of patient the functional outcome is less satisfactory than other sacroiliac disorders 3.

Tanto la artrosis como la pseudoartrosis sacroilica postraumática son entidades poco frecuentes. Se presentan generalmente como complicación del tratamiento de las fracturas de pelvis inestables y su incidencia no supera el 10 por ciento. El objetivo de este trabajo es describir los resultados funcionales y radiográficos de la artrodesis sacroiliaca (ASI) en pacientes con secuelas de fractura de pelvis inestables. Se realizó una revisión retrospectiva de pacientes con fracturas inestables de pelvis tratados por artrosis o pseudoartrosis postraumática con ASI durante el período de 1984 a 2005 en el Hospital del Trabajador de Santiago. De un total de 235 pacientes con fractura inestable de pelvis, 11 presentaron dolor crónico de origen sacroiliaco refractario a tratamiento no quirúrgico que requirió ASI. Nueve fueron hombres y 2 mujeres, el promedio de edad fue de 42 años (rango de 24 a 58). Al momento de la cirugía 7 presentaban artrosis y 4pseudoartrosis postraumática. El tiempo entre el accidente y la ASI fue de 15,8meses en promedio (rango de 6-55). La ASI fue realizada usando el abordaje sacroiliaco posterior, seguido de curetaje articular y aporte de injerto óseo. La fijación se realizó con tornillos canulados y/o placa en todos los pacientes excepto uno. Se realizó una evaluación radiográfica seriada y se utilizó la escala de Majeed para analizar el resultado funcional. El seguimiento promedio fue de 8 años (con un mínimo de un año). Nueve de 11 pacientes lograron fusión sólida. Cinco de 11obtuvieron resultados funcionales excelentes y buenos y 6 de 11 regulares y malos. La ASI se presenta como última alternativa para el manejo dolor sacroiliaco crónico. En este grupo de pacientes, los resultados funcionales logrados son menos satisfactorios que en pacientes con otros desordenes sacroiliacos.

Fijación interna de la articulación sacroiliaca inestable: experiencia Hospital Militar Central, 8 años / Internal fixation of the sacroiliac joint: the experience at Hospital Militar Central

Se diseño un estudio observacional, descriptivo, tipo serie de casos, prospectivo, con el objeto de revisar la experiencia del Servicio de Ortopedia y Traumatología del Hospital Militar Central, Bogota, D.C., Colombia, en el manejo de pacientes con inestabilidad de la articulación sacroiliaca, secundaria a etiologias traumatica o infecciosa. La inestabilidad sacroiliaca es usualmente debida a trauma de alta energia o a severos procesos inflamatorios con osteolisis; en la actualidad dicha inestabilidad es manejada preferencialmente mediante los siguientes metodos de fijación interna: barras iliosacras, tornillos iliosacros percutaneos, placas. Se incluyeron 22 pacientes fijados vía anterior o posterior, por inestabilidad sacroiliaca, secundaria a patologias traumatica o infecciosa, intervenidos entre febrero de 1992 y febrero del 2000. El promedio de edad fue 29 años (14-53) y el promedio de seguimiento 58.8 meses. Los casos se analizaron segun mecanismo de trauma, clasificación, diagnóstico, lesión neurologica preoperatoria y postquirurgica, vias de abordaje, metodo de fijación, lesiones asociadas, complicaciones de la técnica quirurgica y complicaciones generales. La inestabilidad fue traumatica en 20 casos (90.9 por ciento) e infecciosa en 2 casos (9.9 por ciento), en el grupo traumatico la lesion mas frecuente fue la luxofractura de la articulación sacroiliaca con 10 casos (46 por ciento). El abordaje mas empleado fue el posterior percutaneo con 8 casos (36 por ciento), el metodo de fjjación mas utilizado fueron los tornillos iliosacros. Un paciente estabilizado con barras iliosacras, presentó infección profunda; en ningun paciente se reportó seudoartrosis o falla de material En 14 casos (70 por ciento) se hizo necesario adicionalmente la estabilización de la sinfisis pubica, 8 de ellos (57.2 por ciento) con fijador externo y 6 (42.8 por ciento) con placas. La experiencia revisada en el estudio se considera satisfactoria, ya que no se presentaron fallas de material de osteosíntesis ni seudoartrosis; de otra parte, las complicaciónes asociadas son acordes con otros reportes de la literatura e inciden en su presentación la severidad del trauma inicial, del trauma operatorio y/o el retardo en el tratamiento quirurgico

Osteosíntesis sacroilíaca percutánea en fracturas inestables de pelvis / Percutaneous iliosacral fixation of unstable pelvic fractures

La osteosíntesis sacro-ilíaca percutánea con el paciente en posición supina para el tratamiento de las fracturas inestables de pelvis fue descrita en 1993 por Routt, quien destacó las ventajas de estas técnicas sobre los métodos más convencionales. Se reporta un estudio prospectivo en 14 pacientes intervenidos con esta técnica en el Hospital del Trabajador de Santiago con un seguimiento promedio de 19 meses (9-25). El promedio de edad de los pacientes fue de 36 años. Doce pacientes presentaban fracturas tipo C y 2 tipo B según la clasificación de Tile. En 13 pacientes (93 por ciento) se obtuvo una reducción satisfactoria y sólo 1 de 22 tornillos utilizados se encontraba fuera de SI en la TAC de control. Los resultados funcionales según la escala de Majeed fueron excelentes en 11 pacientes, bueno en 1, regular en 1 y malo en otro. Las complicaciones consistieron en una infección profunda y un aflojamiento de un tornillo. Se discuten las ventajas y desventajas de la técnica

Criterios de tratamiento conservador vs quirúrgico en las lesiones del anillo pélvico / Criteria for conservative and surgical treatment for injuries of the pelvic ring

Se hace una revisión del tratamiento tanto conservador como quirúrgico en las disrupciones del anillo pélvico tipo B y C de la clasificación de Tile. Ingresaron 44pacientes al servicio de cirugía de cadera y pelvis del Hospital de Traumatología "Magdalena de las Salinas". Al tipo B1 correspondieron 9 casos (20 por ciento); B2 7 casos (16 por ciento); C3 9 casos (20 por ciento); 26 de ellos se estabilizaron quirúrgicamente; en 19 casos con fijación interna a la artículación sacroiliaca; síntesis al iliaco con placa DCP ancha, 2 casos; un fijador externo únicamente, 5 casos; síntesis al acetábulo, 7 casos y síntesis mixta 4 casos. el tipo B2 y B3, se manejó conservadoramente en un 80 por ciento. El tipo B1 requirió de estabilización con fijador externo, el tipo C1 con fijación interna y/o mixta y el tipo C3 con fijación interna de la pelvis y del acetábulo. Las lesiones asociadas son de importancia y tienen una mortalidad elevada por choque hipovolémico. Se describen los criterios de manejo en este tipo de pacientes desde urgencias

Fratura de Malgaigne em grávidas: relato de 2 casos / Malgaigne fracture in pregnant women: report of 2 cases

Os autores apresentam dois casos de fraturas instáveis da pelve em pacientes grávidas tratadas no Serviço de Ortopedia e Traumatologia da Santa Casa de Porto Alegre. A revisäo dsa literatura näo revelou descriçäo similar