Sacroiliac Joint Dislocation With Ipsilateral Sacral Wing Fracture:Classification System And Surgical Methods Exploration

Objective:Sacroiliac joint dislocation with ipsilateral sacral wing fracture(SJDISWF)is a special type of pelvic fracture,which has a high mortality rate due to the involvement of the sacroiliac joint,poor results of conservative treatment,and high trauma and risk of traditional surgical approaches.The injury has a high mortality rate due to the involvement of the sacroiliac joint.However,due to the lack of knowledge about this injury,there is no standardized treatment plan.The aim of this study was to investigate the injury mechanism and characteristics of SJDISWF,to explore the preliminary typing method of this injury,and to summarize the treatment modalities of each type according to the new typing system and to evaluate the preliminary clinical efficacy.Methods:We collected case data of patients with sacroiliac joint dislocation combined with ipsilateral sacral wing fracture admitted to the Third Affiliated Hospital of Southern Medical University,the Third Hospital of Hebei Medical University and the Red Cross Hospital of Xi’an Jiaotong University from 2013 to 2021,investigated the mechanism of injury and established a preliminary typing method:according to the direction of the sacral wing fracture and the degree,the patients were classified into 3 types:Type Ⅰ:sacroiliac joint dislocation,ipsilateral sacral wing fracture and Type Ⅰ:sacroiliac joint dislocation,with the ipsilateral sacral wing fractured and displac’ed anteriorly in the form of a"floating sacral wing";TypeⅡ:sacroiliac joint dislocation,with the ipsilateral sacral wing fractured in compression or comminuted fracture;Type Ⅲ:sacroiliac joint dislocation,with the ipsilateral sacral wing compressed into the sacral canal.The inter-group reliability and intra-group reliability of the observers were calculated based on two independent typing results of four observers at an interval of 4 weeks,as a way to evaluate the credibility and reproducibility of the new typing;the treatment plan,reduction and fixation results and surgical complications of 31 patients admitted from January 2016 to December 2020 were reviewed to summarize the treatment modalities of each typing and to evaluate the preliminary clinical efficacy.Results:The new staging had a credibility Kappa value of 0.890 and a reproducibility Kappa value of 0.854,and the staging had good credibility and reproducibility.All patients were treated surgically,16 cases were treated with a single anterior approach,4 cases were treated with a combined anterior iliac fossa approach+Stoppa approach,6 cases were fixed with closed repositioning,2 cases were treated with a combined anterior-posterior approach,and 3 cases were treated with a single posterior approach.The excellent rate of Matta score for the quality of fracture repositioning was 84.6%(11/13)for type Ⅰ,82.4%(14/17)for type Ⅱ,and 0%(0/1)for type Ⅲ,with an overall excellent rate of 80.6%.All patients had clinical healing of the fracture site,and the healing time ranged from 8 to 14 weeks,with a mean of 10.3± 1.9 weeks.None of the patients had complications such as progressive decrease in sensory-motor function of the lower extremity,legacy of sacroiliac joint pain,failure of internal fixation or loss of fracture reduction during the follow-up.Conclusion:The SJDISWF classification has high reliability.The classification-oriented treatment strategy has achieved a relatively satisfactory restoration and functional recovery,indicating that the classification has a certain guiding significance for the treatment of SJDISWF.