The following is a summary of “Critical distance of the sacroiliac joint for open reduction using screw fixation for traumatic sacroiliac joint diastasis: a retrospective study,” published in the April 2024 issue of Surgery by Chien et al.
The management of sacroiliac joint (SIJ) diastasis through osteosynthesis involving iliosacral screw (ISS) and trans-iliac-trans-sacral screw (TITSS) fixation presents two primary approaches: closed reduction and open reduction. However, the appropriate indication for open reduction still needs to be discovered in the existing literature.
Methodologically, this retrospective study gathered data from patients afflicted with unilateral traumatic SIJ diastasis who underwent ISS and TITSS fixation, categorizing them into two groups based on their reduction method: closed reduction (C group) and open reduction (O group). Comparative analysis encompassed demographic profiles and perioperative image assessments to elucidate group distinctions. Mainly, attention was devoted to identifying the critical distance of the SIJ, thereby elucidating the rationale for the open reduction in cases of diastatic SIJ.
Results from the analysis, spanning a cohort of 56 patients over 3 years, revealed no significant variance in pelvic ring injury reduction quality between the C and O groups, as assessed by Matta’s and Lefaivre’s criteria. However, the O group notably improved significantly in SIJ distance, particularly in the axial plane on multiplanar computed tomography (p = 0.021). Furthermore, the study proposed a predictive model suggesting that a disparity exceeding 3.71 mm between the injured and healthy SIJ warranted consideration for open reduction, with an area under the curve of 0.791 (95% CI 0.627–0.955, p = 0.004).
In conclusion, the findings suggest that in selected cases, open reduction for SIJ diastasis may yield superior reduction quality compared to closed reduction, particularly in the axial plane. Moreover, the proposed critical distance criterion of 3.71 mm is a valuable guideline for clinicians, signaling that open reduction may be conducive to achieving satisfactory radiological outcomes.
Source: josr-online.biomedcentral.com/articles/10.1186/s13018-024-04759-z
