{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T19:31:00Z","timestamp":1790278260430,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,6,22]],"date-time":"2023-06-22T00:00:00Z","timestamp":1687392000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec><jats:title>Purposes<\/jats:title><jats:p>Screw loosening is a common complication of iliosacral screw fixation, with subsequent loss of stability and fracture re\u2010displacement. This study aimed to investigate the incidence of and risk factors for screw loosening after iliosacral screw fixation for posterior pelvic ring injury.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 135 patients with posterior pelvic ring injuries who were treated with iliosacral screw fixation in our department between July 2015 and April 2021 were selected for this retrospective analysis. The possible risk factors for screw loosening were investigated using univariate and multivariate logistic regression analyses of patient demographics and trauma\u2010related and iatrogenic variables, including age, sex, body mass index, Osteoporosis Self\u2010Assessment Tool for Asians (OSTA) index, mechanism of injury, Young\u2013Burgess classification, site of injury, type of injury, type of screw, mode of fixation, numbers of guidewire adjustments, accuracy of screw position, and quality of fracture reduction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence of screw loosening was 15.6% (<jats:italic>n<\/jats:italic>\u2009=\u200921). The mean duration for screw loosening was 3.2\u2009\u00b1\u20091.5\u2009months after operation. Univariate analysis results showed that the Young\u2013Burgess classification, type of injury, site of injury, type of screw, mode of fixation, and OSTA index might be related to screw loosening (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). According to the multivariate logistic regression, vertical shear injuries (Odds ratios [OR] 9.80, 95% Confidence intervals [CI] [1.96\u201373.28], <jats:italic>p<\/jats:italic>\u2009=\u20090.008), type of injury (OR 0.25, 95% CI [0.13\u20130.79], <jats:italic>p<\/jats:italic>\u2009=\u20090.027), common screws (OR 6.94, 95% CI [1.53\u201331.40], <jats:italic>p<\/jats:italic>\u2009=\u20090.012), screws insertion only at the level of the first sacral segment (S1) (OR 8.79, 95% CI [1.18\u201365.46], <jats:italic>p<\/jats:italic>\u2009=\u20090.034), injury site located in the medial sacral foramina (OR 6.28, 95% CI [1.16\u201334.06], <jats:italic>p<\/jats:italic>\u2009=\u20090.033), and lower OSTA index [OR 0.41, 95% CI [0.24\u20130.71], <jats:italic>p<\/jats:italic>\u2009=\u20090.001] were significantly related to screw loosening.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Vertical shear injuries, sacral fractures, injury site located in the medial sacral foramina, and lower OSTA index are significantly associated with the postoperative occurrence of screw loosening. Transiliac\u2013transsacral screw fixation and screws insertion both at the level of the S1 and second sacral segment can prevent screw loosening.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.13763","type":"journal-article","created":{"date-parts":[[2023,6,24]],"date-time":"2023-06-24T16:00:30Z","timestamp":1687622430000},"page":"1814-1822","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Incidence of and Risk Factors for Screw Loosening after Iliosacral Screw Fixation for Posterior Pelvic Ring Injury"],"prefix":"10.1111","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7474-5297","authenticated-orcid":false,"given":"Wei","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Orthopaedics Surgery General Hospital of Central Theater Command  Wuhan China"},{"name":"School of Medicine Wuhan University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1346-1397","authenticated-orcid":false,"given":"Jianan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery General Hospital of Central Theater Command  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8257-4179","authenticated-orcid":false,"given":"Xuan","family":"Pei","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery General Hospital of Central Theater Command  Wuhan China"},{"name":"School of Medicine Wuhan University of Science and Technology  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peizhao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery General Hospital of Central Theater Command  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guodong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery General Hospital of Central Theater Command  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery General Hospital of Central Theater Command  Wuhan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ximing","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Surgery General Hospital of Central Theater Command  Wuhan 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