Sacroiliac Screw Fixation

The aim of this thesis is to evaluate three major aspects of the use of sacroiliac screws in patients with unstable pelvic ring fractures: the optimal technique for sacroiliac screw fixation, the reliability of peroperative fluoroscopy and the late results. We focused on the questions whether sacroiliac screw fixation can be achieved safely by fluoroscopy, whether it is stable (for possible direct postoperative weight bearing) and if it improves the quality of life after pelvic ring fracture (or after nonunion of this injury). Conclusion: pelvic ring fractures remain a complicated injury. Sacroiliac screw fixation is a technique that has several advantages. Compared to plate or external fixation it allows a stable fixation without extensive wounds that in laboratory results seems stable enough to examine postoperative weight bearing clinically. Despite the fact that neurological injury due to penetration of the screw into the intervertebral foramen still is possible, the addition of the lateral view seems to limit this risk and future techniques such as C.T. guided positioning or robot insertion might decrease the incidence of this complication even further. However even with the current technique no permanent neurological impairment was seen. Finally, combined posterior and anterior fixation seems to improve the quality of life of patients with pelvic ring fractures and with nonunion of the pelvis.

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