Purpose of the study: We present a review of the two-year outcome of a new clinical sacroiliac fixation technique used in our first seven patients.

Material and methods: Between May 2002 and March 2003, seven patients with a Tile C fracture of the pelvic girdle were stabilized with a new operative technique. This technique used two sacral screws linked to two iliac expansive screws via a 5.5 mm rod. Three of the patients presented preoperative neurological injuries attributed to the trauma (L5 or S1 paralysis). All presented associated lesions: lower limb (n=3 patients), spine (n=2), acetabulum (n=2). Mean patient age was 36.3 years. We present a retrospective clinical and radiological review of these seven cases. The Majeed score, the radiological index of lower limb length, and the combined index of vertical displacement and sacroiliac CT results were noted.

Results: The mean Majeed score was 93. Reduction of the combined vertical displacement was considered excellent or good (< 10 mm) in all patients; The reduction in the leg length discrepancy was considered good for all patients. There was no loss of reduction at last follow-up. There were no septic or skin complications and no complications related to implanted material. The implants were removed in one patient. The sacroiliac CT revealed formation of ossification bridges in all patients.

Discussion: The results of our small series are encouraging, particularly for vertical stability over time. There was no case of lysis around the screws and the clinical results were satisfactory.

Conclusion: For us, this technique is the optimal method for the treatment of Tile C injury to the pelvic girdle. This technique enables vertical stabilization while maintaining a certain degree of horizontal mobility facilitating reduction and fixation of the associated anterior injuries. This technique has its limitations since it is not particularly adapted for posterior lesions with fracture of the sacrum in Denis zone 2. These early encouraging results will require further long-term assessment in a larger group of patients.

Purpose: Pelvic girdle fractures with vertical and horizontal instability (Tile classification class C) are classical indications for surgical stabilisation of the posterior and anterior lesions. There is general agreement concerning the anterior fixation, but several methods have been described for the posterior fixation: open or percutaneous sacroiliac screwing using fluoroscopic or computed tomographic guidance, sacral compression bar applied laterally on the posterior iliac masses, sacral screw for sacroiliac fixation using the Galveston technique, among others.

Material and methods: We propose a new sacroiliac fixation technique for fractures of the pelvic girdle associating vertical and horizontal instability (Tile classification class C). This fixation technique controls vertical displacement while authorising, if needed, a certain degree of mobility in the horizontal plane allowing easier reduction of the anterior fracture. This technique uses two sacral screws, one in S1 and the other in S2, and two iliac screws. The iliac screws are inserted in the posterior iliac crest passing through two sacroiliac connectors placed on a rod connecting the two sacral screws. Vertical displacement is controlled by blocking the two connectors on the screw heads. If needed, the connectors can be left unblocked allowing a certain degree of freedom for moving the half-pelvis in the horizontal plane.

Results: This technique was used in four cases. Anatomic reduction was achieved. There was no secondary movement of the osteosynthesis material and no secondary displacement. Because of the quality of the fixation, the sitting position was allowed rapidly as was full-weight bearing and walking. This type of fixation is reserved for type C12 fractures of the Tile classification.

We retrospectively reviewed eight children with idiopathic chondrolysis (IC) of the hip and nine with atrophic tuberculosis (TB) of the hip treated over the 10 years 1990 to 1999. Both conditions present with a stiff hip and radiographic joint space narrowing. Our aim was to delineate clinical, radiological and histological differences between the two conditions, thereby obviating the need for biopsy in IC, which could worsen the prognosis.

In the IC group all patients were girls. Their mean age was 12 years (11.5 to 13). They presented with a flexion abduction and external rotation deformity of the hip. Chest radiographs were normal in all patients, and all except one had an ESR below 20. The Mantoux was negative in six of the eight. Radiographs showed joint space narrowing and osteopoenia, but the subchondral bony line remained present. Four of the eight had a synovial biopsy, which showed non-specific chronic synovitis. The cartilage looked pale and lustreless. In one hip the cartilage was biopsied and showed cartilage necrosis.

In the TB group, five of the nine patients were boys. The mean age was 7 years (5 to 13.5). The only constant hip deformity was flexion. Chest radiographs were normal in all patients. In all patients the ESR was below 20 and the Mantoux was positive. Hip radiographs showed osteopoenia with loss of the subchondral bony line. Peri-articular lytic lesions were present in all patients except one. Histology of synovial biopsy showed caseous necrosis in all hips, and seven of the nine had a positive culture for TB. Macroscopically the cartilage looked normal, and in one hip the cartilage biopsy was histologically normal.

We confirmed that in IC the joint space narrowing is due to cartilage necrosis. We postulate that in atrophic TB the loss of subchondral bone due to subchondral erosion gives the impression of joint space narrowing. We also concluded that IC was a diagnoses per se and not by exclusion, and that biopsy was not required.