Isolated Bilateral Sacroiliac Joint Dislocation Managed by Closed Reduction and Internal Fixation: A Case Report
Abstract
Background: Dislocations of the bilateral sacroiliac (SI) joint are serious injuries. It is extremely rare to experience SI joint dislocation without fracture or disruption of the anterior pelvic ring. Even though SI dislocations can be fixed via several different methods, the surgical technique should be tailored to everyone based on the patient's injuries. The treatment of these fractures with operative intervention remains difficult because of the possibility of other injuries associated with the fractures. Only three cases of this type of injury treated with open reduction and internal fixation (ORIF) have been reported in the literature.
Case Report: A 15-year-old girl presented with high-energy trauma. In the left hand, she had a fracture-dislocation of the wrist; in the right ankle, she had a pilon fracture and a calcaneus fracture. Her pelvis had a bilateral SI dislocation without a fracture in the pelvic ring. After hemodynamic stabilization, surgical management was performed for the wrist fracture-dislocation, as well as the pilon and calcaneus fractures. Four days later, the bilateral SI dislocations were fixed. We performed closed reduction and internal fixation (CRIF) due to the patient's situation and the high risk of infection. At the last follow-up, the fracture had united, and the patient experienced no discomfort in performing her daily activities.
Conclusion: While the optimal method for fixing this injury is unclear, ORIF is the conventional approach for similar cases. However, in this case, CRIF was chosen due to disadvantages associated with ORIF, such as nerve damage, swelling, incomplete bone healing, increased pressure, blood clots, and our patient’s situation.
1. Hungerer S, Woltmann A, Bühren V. Bilateral Sacroiliac Joint Dislocation in an Adolescent after a Skiing Accident. Eur J Trauma Emerg Surg. 2008;34(2):181-7. doi: 10.1007/s00068-007-7055-z. [PubMed: 26815627].
2. Bachhal V, Jindal K, Rathod PM, Kumar D. Bilateral crescent fracture-dislocation of the sacroiliac joint: a case-based discussion and review of literature. Int J Burns Trauma. 2021;11(3):260-6. [PubMed: 34336393]. [PubMed Central: PMC8310864].
3. Wright V, Zelle BA, Prayson M. Bilateral sacroiliac joint dislocation without associated fracture or anterior pelvic ring injuries. J Orthop Trauma. 2004;18(9):634-7. doi: 10.1097/00005131-200410000-00010. [PubMed: 15448454].
4. Chen HW, Liu GD, Fei J, Yi XH, Pan J, Ou S, et al. Treatment of unstable posterior pelvic ring fracture with percutaneous reconstruction plate and percutaneous sacroiliac screws: A comparative study. J Orthop Sci. 2012;17(5):580-7. doi: 10.1007/s00776-012-0257-1. [PubMed: 22810807].
5. Kellam JF, McMurtry RY, Paley D, Tile M. The unstable pelvic fracture. Operative treatment. Orthop Clin North Am. 1987;18(1):25-41. [PubMed: 3796960].
6. Sobhan MR, Abrisham SM, Vakili M, Shirdel S. Spinopelvic Fixation of Sacroiliac Joint Fractures and Fracture- Dislocations: A Clinical 8 Years Follow-Up Study. Arch Bone Jt Surg. 2016;4(4):381-6. [PubMed: 27847854]. [PubMed Central: PMC5100457].
7. Lee CH, Hsu CC, Huang PY. Biomechanical study of different fixation techniques for the treatment of sacroiliac joint injuries using finite element analyses and biomechanical tests. Comput Biol Med. 2017;87:250-7. doi: 10.1016/j.compbiomed.2017.06.007. [PubMed: 28618337].
8. Bi C, Wang Q, Nagelli C, Wu J, Wang Q, Wang J. Treatment of Unstable Posterior Pelvic Ring Fracture with Pedicle Screw-Rod Fixator Versus Locking Compression Plate: A Comparative Study. Med Sci Monit. 2016;22:3764-70. doi: 10.12659/msm.900673. [PubMed: 27748355]. [PubMed Central: PMC5070616].
9. Shaw JC, Routt MLC, Jr., Gary JL. Intra-operative multi- dimensional fluoroscopy of guidepin placement prior to iliosacral screw fixation for posterior pelvic ring injuries and sacroiliac dislocation: an early case series. Int Orthop. 2017;41(10):2171-7. doi: 10.1007/s00264-017-3447-9. [PubMed: 28357493].
10. Xiao J, Wang Y, Zhang M, Jiang R, Zhu T, Liu G, et al. Anterior fracture dislocation of the sacroiliac joint: A case report and literature review. Technol Health Care. 2017;25(4):803-8. doi: 10.3233/thc-160735. [PubMed: 28436402].
11. Loupasis G, Anastopoulos G, Asimakopoulos A. Pure bilateral sacroiliac dislocation with intact anterior pelvis. Injury. 2005;36(11):1379-82. doi: 10.1016/j.injury.2005.04.006. [PubMed: 16214480].
12. Nagi ON, Dhillon MS, Gill SS. Bilateral fracture dislocation of the sacrum without injury to the anterior pelvis. Orthopedics. 1993;16(2):215-7. doi: 10.3928/0147-7447-19930201-17. [PubMed: 8441722].
13. Pohlemann T, Tscherne H, Baumgärtel F, Egbers HJ, Euler E, Maurer F, et al. [Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group]. Unfallchirurg. 1996;99(3):160-7. [PubMed: 8685720].
14. Melton LJ, 3rd, Sampson JM, Morrey BF, Ilstrup DM. Epidemiologic features of pelvic fractures. Clin Orthop Relat Res. 1981(155):43-7. [PubMed: 7226629].
15. Siegmeth A, Müllner T, Kukla C, Vécsei V. [Associated injuries in severe pelvic trauma]. Unfallchirurg. 2000;103(7):572-81. doi: 10.1007/s001130050585. [PubMed: 10969545].16. Rieger H, Brug E. Fractures of the pelvis in children. Clin Orthop Relat Res. 1997(336):226-39. doi: 10.1097/00003086- 199703000-00031. [PubMed: 9060509].
17. LaFollette BF, Levine MI, McNiesh LM. Bilateral fracture- dislocation of the sacrum. A case report. J Bone Joint Surg Am. 1986;68(7):1099-101. [PubMed: 3745252].
18. Marcus RE, Hansen ST, Jr. Bilateral fracture-dislocation of the sacrum. A case report. J Bone Joint Surg Am. 1984;66(8):1297-9. [PubMed: 6490707].
19. Torok G. Bilateral sacroiliac joint dislocation with intrapelvic intrusion of the intact lumbosacral spine and sacrum. J Trauma. 1976;16(11):930-4. doi: 10.1097/00005373-197611000-00014. [PubMed: 994273].
20. Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br. 1988;70(1):1-12. doi: 10.1302/0301-620x.70b1.3276697. [PubMed: 3276697].
21. Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clin Orthop Relat Res. 1989(242):83-97. [PubMed: 2706863].
22. Dujardin FH, Hossenbaccus M, Duparc F, Biga N, Thomine JM. Long-term functional prognosis of posterior injuries in high- energy pelvic disruption. J Orthop Trauma. 1998;12(3):145-50; discussion 50-1. doi: 10.1097/00005131-199803000-00001. [PubMed: 9553853].
23. Cole JD, Blum DA, Ansel LJ. Outcome after fixation of unstable posterior pelvic ring injuries. Clin Orthop Relat Res. 1996(329):160-79. doi: 10.1097/00003086-199608000-00020. [PubMed: 8769448].
24. Pohlemann T, Bosch U, Gänsslen A, Tscherne H. The Hannover experience in management of pelvic fractures. Clin Orthop Relat Res. 1994(305):69-80. [PubMed: 8050249].
25. Arand M, Kinzl L, Gebhard F. Computer-guidance in percutaneous screw stabilization of the iliosacral joint. Clin Orthop Relat Res. 2004(422):201-7. doi: 10.1097/01.blo.0000128644.46013.08. [PubMed: 15187858].
26. Borrelli J, Jr., Koval KJ, Helfet DL. Operative stabilization of fracture dislocations of the sacroiliac joint. Clin Orthop Relat Res. 1996(329):141-6. doi: 10.1097/00003086-199608000-00017. [PubMed: 8769445].
27. Dabezies EJ, Millet CW, Murphy CP, Acker JH, Robicheaux RE, D'Ambrosia RD. Stabilization of sacroiliac joint disruption with threaded compression rods. Clin Orthop Relat Res. 1989(246):165-71. [PubMed: 2766606].
28. Albert MJ, Miller ME, MacNaughton M, Hutton WC. Posterior pelvic fixation using a transiliac 4.5-mm reconstruction plate: A clinical and biomechanical study. J Orthop Trauma. 1993;7(3):226-32. doi: 10.1097/00005131-199306000-00005. [PubMed: 8326426].
29. Roy-Camille R, Saillant G, Gagna G, Mazel C. Transverse fracture of the upper sacrum. Suicidal jumper's fracture. Spine (Phila Pa 1976). 1985;10(9):838-45. doi: 10.1097/00007632- 198511000-00011. [PubMed: 4089659].
30. Duwelius PJ, Van Allen M, Bray TJ, Nelson D. Computed tomography-guided fixation of unstable posterior pelvic ring disruptions. J Orthop Trauma. 1992;6(4):420-6. doi: 10.1097/00005131-199212000-00005. [PubMed: 1494094].
31. Leighton RK, Waddell JP. Techniques for reduction and posterior fixation through the anterior approach. Clin Orthop Relat Res. 1996(329):115-20. doi: 10.1097/00003086-199608000-00014. [PubMed: 8769442].
32. Shuler TE, Boone DC, Gruen GS, Peitzman AB. Percutaneous iliosacral screw fixation: early treatment for unstable posterior pelvic ring disruptions. J Trauma. 1995;38(3):453-8. doi: 10.1097/00005373-199503000-00031. [PubMed: 7897737].
33. Vanderschot P, Meuleman C, Lefèvre A, Broos P. Trans iliac- sacral-iliac bar stabilisation to treat bilateral lesions of the sacro-iliac joint or sacrum: anatomical considerations and clinical experience. Injury. 2001;32(7):587-92. doi: 10.1016/s0020-1383(01)00039-0. [PubMed: 11524094].
34. Vanderschot PM, Broens PM, Vermeire JI, Broos PL. Trans iliac- sacral-iliac bar stabilization to treat bilateral sacro-iliac joint disruptions. Injury. 1999;30(9):637-40. doi: 10.1016/s0020- 1383(99)00162-x. [PubMed: 10707235].
35. Simpson LA, Waddell JP, Leighton RK, Kellam JF, Tile M. Anterior approach and stabilization of the disrupted sacroiliac joint. J Trauma. 1987;27(12):1332-9. doi: 10.1097/00005373-198712000-00003. [PubMed: 3694724].
36. Moon CN, Merkle PF. A level one trauma center's experience with the posterior approach to the pelvis. Orthopedics. 2002;25(2):159-62. doi: 10.3928/0147-7447-20020201-20. [PubMed: 11866148].
37. Abumi K, Saita M, Iida T, Kaneda K. Reduction and fixation of sacroiliac joint dislocation by the combined use of S1 pedicle screws and the galveston technique. Spine (Phila Pa 1976). 2000;25(15):1977-83. doi: 10.1097/00007632-200008010-00018. [PubMed: 10908943].
38. Schildhauer TA, Ledoux WR, Chapman JR, Henley MB, Tencer AF, Routt ML, Jr. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma. 2003;17(1):22-31. doi: 10.1097/00005131-200301000-00004. [PubMed: 12499964].
39. Grossterlinden L, Rueger J, Catala-Lehnen P, Rupprecht M, Lehmann W, Rücker A, et al. Factors influencing the accuracy of iliosacral screw placement in trauma patients. Int Orthop. 2011;35(9):1391-6. doi: 10.1007/s00264-010-1092-7. [PubMed: 20640933]. [PubMed Central: PMC3167462].
2. Bachhal V, Jindal K, Rathod PM, Kumar D. Bilateral crescent fracture-dislocation of the sacroiliac joint: a case-based discussion and review of literature. Int J Burns Trauma. 2021;11(3):260-6. [PubMed: 34336393]. [PubMed Central: PMC8310864].
3. Wright V, Zelle BA, Prayson M. Bilateral sacroiliac joint dislocation without associated fracture or anterior pelvic ring injuries. J Orthop Trauma. 2004;18(9):634-7. doi: 10.1097/00005131-200410000-00010. [PubMed: 15448454].
4. Chen HW, Liu GD, Fei J, Yi XH, Pan J, Ou S, et al. Treatment of unstable posterior pelvic ring fracture with percutaneous reconstruction plate and percutaneous sacroiliac screws: A comparative study. J Orthop Sci. 2012;17(5):580-7. doi: 10.1007/s00776-012-0257-1. [PubMed: 22810807].
5. Kellam JF, McMurtry RY, Paley D, Tile M. The unstable pelvic fracture. Operative treatment. Orthop Clin North Am. 1987;18(1):25-41. [PubMed: 3796960].
6. Sobhan MR, Abrisham SM, Vakili M, Shirdel S. Spinopelvic Fixation of Sacroiliac Joint Fractures and Fracture- Dislocations: A Clinical 8 Years Follow-Up Study. Arch Bone Jt Surg. 2016;4(4):381-6. [PubMed: 27847854]. [PubMed Central: PMC5100457].
7. Lee CH, Hsu CC, Huang PY. Biomechanical study of different fixation techniques for the treatment of sacroiliac joint injuries using finite element analyses and biomechanical tests. Comput Biol Med. 2017;87:250-7. doi: 10.1016/j.compbiomed.2017.06.007. [PubMed: 28618337].
8. Bi C, Wang Q, Nagelli C, Wu J, Wang Q, Wang J. Treatment of Unstable Posterior Pelvic Ring Fracture with Pedicle Screw-Rod Fixator Versus Locking Compression Plate: A Comparative Study. Med Sci Monit. 2016;22:3764-70. doi: 10.12659/msm.900673. [PubMed: 27748355]. [PubMed Central: PMC5070616].
9. Shaw JC, Routt MLC, Jr., Gary JL. Intra-operative multi- dimensional fluoroscopy of guidepin placement prior to iliosacral screw fixation for posterior pelvic ring injuries and sacroiliac dislocation: an early case series. Int Orthop. 2017;41(10):2171-7. doi: 10.1007/s00264-017-3447-9. [PubMed: 28357493].
10. Xiao J, Wang Y, Zhang M, Jiang R, Zhu T, Liu G, et al. Anterior fracture dislocation of the sacroiliac joint: A case report and literature review. Technol Health Care. 2017;25(4):803-8. doi: 10.3233/thc-160735. [PubMed: 28436402].
11. Loupasis G, Anastopoulos G, Asimakopoulos A. Pure bilateral sacroiliac dislocation with intact anterior pelvis. Injury. 2005;36(11):1379-82. doi: 10.1016/j.injury.2005.04.006. [PubMed: 16214480].
12. Nagi ON, Dhillon MS, Gill SS. Bilateral fracture dislocation of the sacrum without injury to the anterior pelvis. Orthopedics. 1993;16(2):215-7. doi: 10.3928/0147-7447-19930201-17. [PubMed: 8441722].
13. Pohlemann T, Tscherne H, Baumgärtel F, Egbers HJ, Euler E, Maurer F, et al. [Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group]. Unfallchirurg. 1996;99(3):160-7. [PubMed: 8685720].
14. Melton LJ, 3rd, Sampson JM, Morrey BF, Ilstrup DM. Epidemiologic features of pelvic fractures. Clin Orthop Relat Res. 1981(155):43-7. [PubMed: 7226629].
15. Siegmeth A, Müllner T, Kukla C, Vécsei V. [Associated injuries in severe pelvic trauma]. Unfallchirurg. 2000;103(7):572-81. doi: 10.1007/s001130050585. [PubMed: 10969545].16. Rieger H, Brug E. Fractures of the pelvis in children. Clin Orthop Relat Res. 1997(336):226-39. doi: 10.1097/00003086- 199703000-00031. [PubMed: 9060509].
17. LaFollette BF, Levine MI, McNiesh LM. Bilateral fracture- dislocation of the sacrum. A case report. J Bone Joint Surg Am. 1986;68(7):1099-101. [PubMed: 3745252].
18. Marcus RE, Hansen ST, Jr. Bilateral fracture-dislocation of the sacrum. A case report. J Bone Joint Surg Am. 1984;66(8):1297-9. [PubMed: 6490707].
19. Torok G. Bilateral sacroiliac joint dislocation with intrapelvic intrusion of the intact lumbosacral spine and sacrum. J Trauma. 1976;16(11):930-4. doi: 10.1097/00005373-197611000-00014. [PubMed: 994273].
20. Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br. 1988;70(1):1-12. doi: 10.1302/0301-620x.70b1.3276697. [PubMed: 3276697].
21. Matta JM, Saucedo T. Internal fixation of pelvic ring fractures. Clin Orthop Relat Res. 1989(242):83-97. [PubMed: 2706863].
22. Dujardin FH, Hossenbaccus M, Duparc F, Biga N, Thomine JM. Long-term functional prognosis of posterior injuries in high- energy pelvic disruption. J Orthop Trauma. 1998;12(3):145-50; discussion 50-1. doi: 10.1097/00005131-199803000-00001. [PubMed: 9553853].
23. Cole JD, Blum DA, Ansel LJ. Outcome after fixation of unstable posterior pelvic ring injuries. Clin Orthop Relat Res. 1996(329):160-79. doi: 10.1097/00003086-199608000-00020. [PubMed: 8769448].
24. Pohlemann T, Bosch U, Gänsslen A, Tscherne H. The Hannover experience in management of pelvic fractures. Clin Orthop Relat Res. 1994(305):69-80. [PubMed: 8050249].
25. Arand M, Kinzl L, Gebhard F. Computer-guidance in percutaneous screw stabilization of the iliosacral joint. Clin Orthop Relat Res. 2004(422):201-7. doi: 10.1097/01.blo.0000128644.46013.08. [PubMed: 15187858].
26. Borrelli J, Jr., Koval KJ, Helfet DL. Operative stabilization of fracture dislocations of the sacroiliac joint. Clin Orthop Relat Res. 1996(329):141-6. doi: 10.1097/00003086-199608000-00017. [PubMed: 8769445].
27. Dabezies EJ, Millet CW, Murphy CP, Acker JH, Robicheaux RE, D'Ambrosia RD. Stabilization of sacroiliac joint disruption with threaded compression rods. Clin Orthop Relat Res. 1989(246):165-71. [PubMed: 2766606].
28. Albert MJ, Miller ME, MacNaughton M, Hutton WC. Posterior pelvic fixation using a transiliac 4.5-mm reconstruction plate: A clinical and biomechanical study. J Orthop Trauma. 1993;7(3):226-32. doi: 10.1097/00005131-199306000-00005. [PubMed: 8326426].
29. Roy-Camille R, Saillant G, Gagna G, Mazel C. Transverse fracture of the upper sacrum. Suicidal jumper's fracture. Spine (Phila Pa 1976). 1985;10(9):838-45. doi: 10.1097/00007632- 198511000-00011. [PubMed: 4089659].
30. Duwelius PJ, Van Allen M, Bray TJ, Nelson D. Computed tomography-guided fixation of unstable posterior pelvic ring disruptions. J Orthop Trauma. 1992;6(4):420-6. doi: 10.1097/00005131-199212000-00005. [PubMed: 1494094].
31. Leighton RK, Waddell JP. Techniques for reduction and posterior fixation through the anterior approach. Clin Orthop Relat Res. 1996(329):115-20. doi: 10.1097/00003086-199608000-00014. [PubMed: 8769442].
32. Shuler TE, Boone DC, Gruen GS, Peitzman AB. Percutaneous iliosacral screw fixation: early treatment for unstable posterior pelvic ring disruptions. J Trauma. 1995;38(3):453-8. doi: 10.1097/00005373-199503000-00031. [PubMed: 7897737].
33. Vanderschot P, Meuleman C, Lefèvre A, Broos P. Trans iliac- sacral-iliac bar stabilisation to treat bilateral lesions of the sacro-iliac joint or sacrum: anatomical considerations and clinical experience. Injury. 2001;32(7):587-92. doi: 10.1016/s0020-1383(01)00039-0. [PubMed: 11524094].
34. Vanderschot PM, Broens PM, Vermeire JI, Broos PL. Trans iliac- sacral-iliac bar stabilization to treat bilateral sacro-iliac joint disruptions. Injury. 1999;30(9):637-40. doi: 10.1016/s0020- 1383(99)00162-x. [PubMed: 10707235].
35. Simpson LA, Waddell JP, Leighton RK, Kellam JF, Tile M. Anterior approach and stabilization of the disrupted sacroiliac joint. J Trauma. 1987;27(12):1332-9. doi: 10.1097/00005373-198712000-00003. [PubMed: 3694724].
36. Moon CN, Merkle PF. A level one trauma center's experience with the posterior approach to the pelvis. Orthopedics. 2002;25(2):159-62. doi: 10.3928/0147-7447-20020201-20. [PubMed: 11866148].
37. Abumi K, Saita M, Iida T, Kaneda K. Reduction and fixation of sacroiliac joint dislocation by the combined use of S1 pedicle screws and the galveston technique. Spine (Phila Pa 1976). 2000;25(15):1977-83. doi: 10.1097/00007632-200008010-00018. [PubMed: 10908943].
38. Schildhauer TA, Ledoux WR, Chapman JR, Henley MB, Tencer AF, Routt ML, Jr. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma. 2003;17(1):22-31. doi: 10.1097/00005131-200301000-00004. [PubMed: 12499964].
39. Grossterlinden L, Rueger J, Catala-Lehnen P, Rupprecht M, Lehmann W, Rücker A, et al. Factors influencing the accuracy of iliosacral screw placement in trauma patients. Int Orthop. 2011;35(9):1391-6. doi: 10.1007/s00264-010-1092-7. [PubMed: 20640933]. [PubMed Central: PMC3167462].
| Files | ||
| Issue | Vol 12 No 3 (2026) | |
| Section | Case Report | |
| Keywords | ||
| Sacroiliac Joint Hip Dislocation Closed Fracture Reduction | ||
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How to Cite
1.
Yeganeh A, Amiri S, Babaei M, Komijani M. Isolated Bilateral Sacroiliac Joint Dislocation Managed by Closed Reduction and Internal Fixation: A Case Report. J Orthop Spine Trauma. 2026;12(3):135-8.
