Surgical management and outcomes of pure sacroiliac joint dislocations: A systematic review.

Introduction: Sacroiliac joint (SIJ) dislocations, particularly pure SIJ dislocations without associated fractures, represent a rare and complex subset of pelvic ring injuries. Given the intricate pelvic anatomy and the need to achieve both stability and functional recovery, the optimal surgical management for these injuries remains a topic of debate. This systematic review aims to evaluate the various surgical techniques employed in treating this rare and challenging injury and assess associated clinical outcomes and complications. Materials and methods: A systematic review was conducted adhering to the PRISMA guidelines. Relevant studies were searched in four databases: Pubmed, Scopus, Embase, and Medline. The selected articles were evaluated according to the criteria of levels of evidence. The included studies were analyzed using the Methodological index for non-randomized studies (MINORS) criteria for quality assessment. This paper was registered in the International Prospective Registry of Systematic Reviews (PROSPERO). Results: The review identified four studies. The surgical techniques varied across studies, with percutaneous fixation, open reduction and internal fixation (ORIF), and combined approaches being the most reported methods. Clinical outcomes generally indicated satisfactory pain relief and functional recovery (Majeed score 57-90), though the rates of complications, including hardware failure (4-17 %) and infection (17-32 %), were notable. The results also highlighted that anatomical reduction and stable fixation are crucial for optimizing outcomes and minimizing complications. However, the heterogeneity of the data, especially the timing of surgery and surgical technique, precluded a formal meta-analysis. Conclusions: Surgical management of pure SIJ dislocations presents significant challenges due to the complex biomechanics of the pelvic ring. While various surgical techniques have been employed with generally positive outcomes, the lack of high-quality, large-scale studies limits the ability to establish definitive guidelines. Early definitive treatment of these injuries and anatomical reduction of the SIJ are the main factors to improve clinical outcomes and reduce complication rates. Level of evidence: IV.