{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T06:31:47Z","timestamp":1765780307386,"version":"3.48.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sacroiliac joint dysfunction (SIJD) is an underrecognized source of postoperative pain and disability after pelvic ring stabilization. Although percutaneous sacroiliac screw fixation provides stable fixation with low morbidity, it restricts physiological SI joint micromotion, potentially causing iatrogenic dysfunction. The relative contributions of injury severity vs. fixation strategy to SIJD remain poorly defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the incidence and factors associated with SIJD after sacroiliac screw fixation for posterior pelvic ring injuries, focusing on fixation laterality (unilateral vs. bilateral) and patient characteristics. Secondary aims included evaluating the functional impact of SIJD on long-term outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single-center retrospective cohort study with prospective follow-up included 80 patients [mean follow-up: 42.3\u2009\u00b1\u200927.3 months; median 36 months (IQR: 16\u201356)] who underwent sacroiliac screw fixation between 2016 and 2024. Fracture morphology was classified using Tile and Young\u2013Burgess systems. SIJD was diagnosed prospectively based on \u22653 positive provocation tests. Functional outcomes were assessed using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), and Lower Extremity Functional Scale (LEFS). Statistical analyses included chi-square, Mann\u2013Whitney\n                      <jats:italic>U<\/jats:italic>\n                      , Cohen's\n                      <jats:italic>\u03ba<\/jats:italic>\n                      , effect sizes (Cohen's\n                      <jats:italic>d<\/jats:italic>\n                      ), and multivariate logistic regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      SIJD occurred in 20 patients (25%), exclusively after unilateral fixation, whereas none followed bilateral fixation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). SIJD-positive patients were younger (32.1\u2009\u00b1\u20099.0 vs. 41.5\u2009\u00b1\u200912.8 years,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Fracture morphology showed no consistent association. At \u226512-month follow-up, SIJD-positive patients had worse outcomes (ODI: 37.3 vs. 10.3; VAS: 5.7 vs. 1.6; LEFS: 33.5 vs. 70.3; all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Multivariate analysis identified younger age as an independent predictor (OR 1.8 per decade,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Unilateral fixation is associated with a higher incidence of SIJD, particularly in younger patients. Given the retrospective design, findings should be interpreted as associative and hypothesis-generating rather than confirmatory. Fixation strategy, rather than fracture morphology, appears to be the key associated factor. SIJD causes substantial long-term disability and pain, underscoring the need for individualized fixation planning and prospective validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>Level III (Retrospective cohort with prospective follow-up).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2025.1719425","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T06:28:03Z","timestamp":1765780083000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Age and fixation strategy as associated factors for sacroiliac joint dysfunction after posterior pelvic ring fixation"],"prefix":"10.3389","volume":"12","author":[{"given":"Cemil","family":"Aktan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c7ile","family":"Aktan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammed","family":"Erg\u00fcn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Halil Yal\u00e7\u0131n","family":"Y\u00fcksel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alpaslan","family":"Erol","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1440","DOI":"10.1213\/01.ANE.0000180831.60169.EA","article-title":"Sacroiliac joint pain: a comprehensive review of anatomy, diagnosis, and treatment","volume":"101","author":"Cohen","year":"2005","journal-title":"Anesth Analg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1097\/00007632-198111000-00015","article-title":"Macroscopic and microscopic anatomy of the sacroiliac joint from embryonic life until the eighth decade","volume":"6","author":"Bowen","year":"1981","journal-title":"Spine (Phila Pa 1976)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"505","DOI":"10.1007\/s004290050200","article-title":"Age-related changes in the articular cartilage of human sacroiliac joint","volume":"198","author":"Kampen","year":"1998","journal-title":"Anat Embryol (Berl)"},{"key":"B4","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1179\/jmt.2008.16.3.142","article-title":"Evidence-based diagnosis and treatment of the painful sacroiliac joint","volume":"16","author":"Laslett","year":"2008","journal-title":"J Man Manip Ther"},{"key":"B5","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1097\/BOT.0000000000001356","article-title":"Unstable pelvic ring injuries: how soon can patients safely bear weight?","volume":"33","author":"Marchand","year":"2019","journal-title":"J Orthop Trauma"},{"key":"B6","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1186\/s12891-022-05536-x","article-title":"Percutaneous posterior transiliac plate versus iliosacral screw fixation for posterior fixation of Tile C-type pelvic fractures: a retrospective comparative study","volume":"23","author":"Kim","year":"2022","journal-title":"BMC Musculoskelet Disord"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1814","DOI":"10.1111\/os.13763","article-title":"Incidence of and risk factors for screw loosening after iliosacral screw fixation for posterior pelvic ring injury","volume":"15","author":"Zhou","year":"2023","journal-title":"Orthop Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"194","DOI":"10.3390\/jcm13010194","article-title":"Stabilization of traumatic iliosacral instability using innovative implants: a biomechanical comparison","volume":"13","author":"Gr\u00fcneweller","year":"2023","journal-title":"J Clin Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1302\/0301-620X.70B1.3276697","article-title":"Pelvic ring fractures: should they be fixed?","volume":"70","author":"Tile","year":"1988","journal-title":"J Bone Joint Surg Br"},{"key":"B10","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1148\/radiology.160.2.3726125","article-title":"Pelvic fractures: value of plain radiography in early assessment and management","volume":"160","author":"Young","year":"1986","journal-title":"Radiology"},{"key":"B11","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.math.2005.01.003","article-title":"Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests","volume":"10","author":"Laslett","year":"2005","journal-title":"Man Ther"},{"key":"B12","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1097\/00007632-199407000-00011","article-title":"Sacroiliac joint: pain referral maps upon applying a new injection\/arthrography technique. 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