Evaluation of Fluoroscopic-Guided Closed Reduction versus Open Reduction of Sacroiliac Fracture-Luxations Stabilized with a Lag Screw.

Abstract

OBJECTIVE:  The aim of this study was to compare radiographic outcomes of open reduction versus fluoroscopic-guided closed reduction (FGCR) of sacroiliac fracture-luxations stabilized with a lag screw, as well as peri- and postoperative complications. STUDY DESIGN:  Medical records (2010-2015) and radiographs of dogs and cats diagnosed with sacroiliac fracture-luxation that underwent open reduction without fluoroscopic guidance ( = 24) or FGCR ( = 17) were retrospectively reviewed to assess sacroiliac fracture-luxation reduction and lag screw placement, and lag screw loosening on follow-up radiographs (range, 1-8 weeks postoperatively) when available. Peri- and postoperative complications were also recorded. RESULTS:  Optimal screw depth to sacral body width ratio (>60%) was achieved in a significantly higher proportion of FGCR cases than openly reduced fracture-luxations. A significantly lower rate of lag screw loosening was found for FGCR cases. Few peri- and postoperative complications were noted across both groups. Four out of 17 FGCR cases requiring conversion to an open approach were excluded from data analysis; they had a longer duration from trauma to surgical repair than the median duration from trauma to surgical repair for cases successfully reduced in closed fashion. CONCLUSION:  Fluoroscopic-guided closed reduction of sacroiliac fracture-luxations leads to consistently more optimal screw placement, as well as a lower incidence of lag screw loosening on follow-up radiographs. However, for cases with a longer duration from trauma to surgical repair, one should be prepared to convert to an open approach if a closed approach is not amenable to adequate reduction and lag screw placement.