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Crescent Frx: (Sacroiliac Fracture)

- Discussion:
    - involves a combination of ligamentous injury at inferior portion of SI joint, and verticle fracture of the posterior ilium which
           extends thru iliac crest;
           - posterior superior iliac spine remain attached to the sacrum;
    - often occurs as a part of lateral compression fractures;
           - frx often remains stable to vertical forces because sacrospinous and sarcrotuberous ligaments remain intact;
    - this fracture pattern needs to be distinguished from iliac fractures that extend from the iliac crest into the greater sciatic
           notch, sparing the sacroiliac joint;
           - these iliac fractures may be associated with gluteal vascular injuries;

- Radiographs:


- Operative Managment:
    - consider  direct frx fixation from iliac crest into sacrum;
    - incision:
          - short vertical incision is made 1 fingerbreadth lateral to PSIS;
          - subperiosteally dissect the fascia and gluteus maximus off the PSIS and continue the dissection laterally to expose the fracture;
          - frx site is irrigated and debrided of loose tissue;
    - reduction and fixation:
          - anterior approach:
                 - involves plate fixation of the anterior SI joint;
                 - avoid overcompression of the anterior aspect of the SI joint;
                        - overcompression causes posterior portions of SI joint to become distracted which causes internal rotational deformity
                                 of affected hemipelvis;
                        - this is avoided by appropriate contouring of the plate;
          - posterior approach
                 - iliac frx is reduced to the PSIS fragment;
                 - insert two screws (3.5 cortical lag screws or 4.0 mm partially theaded cancellous screws) from posterior to anterior to
                           maintain the reduction;
                 - generally two screws are not enough to control rotational forces, and hence a 3.5 reconstruction plate should be contoured
                           and applied to the outer Iliac table across the fracture site

Percutaneous Screw Fixation of Crescent Fracture-Dislocation of the Sacroiliac Joint

The Crescent Fracture: a Posterior Fracture Dislocation of the Sacroiliac Joint.

Morbidity associated with isolated iliac wing fractures

Comminuted fractures of the iliac wing.

[Operation via anterior approach in treating pelvic crescent fracture].

Posterior Iliac Crescent Fracture-dislocation: Is It Only Rotationally Unstable?