Surgical Management of Sacroiliac Joint Dislocations and Crescent Fractures: A Nine-Year Clinical Follow-Up.

Background: Pelvic injuries of the sacroiliac joint are unstable and require surgical intervention following high-energy trauma. In this study, we aimed to present the long-term clinical outcomes of patients with sacroiliac joint separation and sacroiliac fracture dislocation (crescent) injury. We compared the surgical interventions performed on the sacroiliac joint based on patient clinical data. Methods: By reviewing the records of 850 pelvic fractures treated in our clinic between 2000 and 2020, we identified 110 patients with sacroiliac joint injuries who were included in the study. The fractures were classified based on patient files and radiographs. The patients were categorized according to the surgical interventions performed on the sacroiliac joint into two groups: closed reduction with percutaneous iliosacral screws and open reduction with plates and screws. We further divided the patients who underwent open reduction and plate-screw fixation into anterior and posterior surgical approaches. Clinical outcomes were obtained by evaluating patients using a subjective pelvic scoring system. Additionally, complications observed after surgeries were investigated. Results: A total of 121 fractures from 110 patients were included in the study. Eleven of the patients had bilateral sacroiliac joint injuries, for which bilateral surgery was performed. The mean age of the patients at the time of injury was 35.15 years (range from 6 to 80 years). The mean follow-up period was 103.45 months (range from 16 to 253 months). According to the scoring system, the highest success rate was observed in plate-screw operations performed through the anterior approach to the sacroiliac joint, with excellent to good results in approximately 92% of patients. Both open reduction and internal fixation through the posterior approach and closed reduction and percutaneous iliosacral screw surgery yielded successful functional results, with no statistically significant difference between the methods (p = 0.880). Regarding complications, the most important problems were infections associated with plate-screw procedures using the posterior approach and neurologic injuries resulting from closed reduction screw surgery. Conclusions: Effective management of sacroiliac joint injuries requires surgical expertise and individualized treatment strategies. With appropriate technique and fixation, both open and closed surgical methods can achieve satisfactory anatomical reduction and functional outcomes. Although standardized treatment protocols may be developed, tailoring the approach to each patient is more important for optimal clinical success.