title: Do Transsacral-transiliac Screws Across Uninjured Sacroiliac Joints Affect Pain and Functional Outcomes in Trauma Patients?
abstract: BACKGROUND
  Patients with pelvic ring displacement and instability can benefit from surgical reduction and instrumentation to stabilize the pelvis and improve functional outcomes. Current treatments include iliosacral screw or transsacral-transiliac screw, which provides greater biomechanical stability. However, controversy exists regarding the effects of placement of a screw across an uninjured sacroiliac joint for pelvis stabilization after trauma.
  
  
  OBJECTIVE
  Does transsacral-transiliac screw fixation of an uninjured sacroiliac joint increase pain and worsen functional outcomes at minimum 1-year followup compared with patients undergoing standard iliosacral screw fixation across the injured sacroiliac joint in patients who have sustained pelvic trauma?
  
  
  METHODS
  All patients between ages 18 and 84 years who sustained injuries to the pelvic ring (AO/OTA 61 A, B, C) who were surgically treated between 2011 and 2013 at an academic Level I trauma center were identified for selection. We included patients with unilateral sacroiliac disruption or sacral fractures treated with standard iliosacral screws across an injured hemipelvis and/or transsacral-transiliac screws placed in the posterior ring. Transsacral-transiliac screws were generally more likely to be used in patients with vertically unstable sacral injuries of the posterior ring as a result of previous reports of failures or in osteopenic patients. We excluded patients with bilateral posterior pelvic ring injuries, fixation with a device other than a screw, previous pelvic or acetabular fractures, associated acetabular fractures, and ankylosing spondylitis. Of the 110 patients who met study criteria, 53 (44%) were available for followup at least 12 months postinjury. Sixty patients were unable to be contacted by phone or mail and seven declined to participate in the study. Outcomes were obtained by members of the research team using the visual analog scale (VAS) pain score for both posterior sacroiliac joints, Short Musculoskeletal Functional Assessment (SMFA), and Majeed scores. Patients completed the forms by themselves when able to return to the clinic. A phone interview was performed for others after they received the outcome forms by mail or email.
  
  
  RESULTS
  There were no differences between iliosacral and transsacral-transiliac in terms of VAS injured (2.9 ± 2.9 versus 3.0 ± 2.8, mean difference = 0.1 [95% confidence interval, -1.6 to 1.7], p = 0.91), VAS uninjured (1.8 ± 2.4 versus 2.0 ± 2.6, mean difference = 0.2 [-1.3 to 1.6], p = 0.82), Majeed (80.3 ± 19.9, 79.3 ± 17.5, mean difference = 1.0 [-11.6 to 9.6], p = 0.92), SMFA Function (22.8 ± 22.2, 21.0 ± 17.6, mean difference = 1.8 [-13.2 to 9.6], p = 0.29, and SMFA Bother (24.3 ± 23.8, 29.7 ± 23.4, mean difference = 5.4 [-7.8 to 18.6], p = 0.42).
  
  
  CONCLUSIONS
  Placement of fixation across a contralateral, uninjured sacroiliac joint resulted in no differences in pain and function when compared with standard iliosacral screw placement across an injured hemipelvis at least 1 year after instrumentation. When needed for biomechanical stability, transsacral-transiliac fixation across an uninjured sacroiliac joint can be used without expectation of positive or negative effects on pain or functional outcomes at minimum 1-year followup.
  
  
  METHODS
  Level III, therapeutic study.
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: John
authors.initials: J
authors.lastname: Heydemann
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Braden
authors.initials: B
authors.lastname: Hartline
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Gibson
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Catherine G
authors.initials: CG
authors.lastname: Ambrose
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Munz
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Galpin
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Achor
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Medical School at Houston, Houston, TX, USA. joshgary14@gmail.com.|Department of Orthopaedic Surgery, University of Texas Medical School at Houston, 6400 Fannin Street, Suite 1700, Houston, TX, 77030, USA. joshgary14@gmail.com.
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Gary
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D007085:Ilium / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology*; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult