Bilateral Sacroiliac Joint Dislocation in an Adolescent after a Skiing Accident.

A bilateral sacroiliac joint (SI joint) dislocation is a rare injury pattern, in contrast to bilateral fracture dislocations of the SI joint. The incidence of pelvic dislocation of the SI joint without significant bone structural damage would most likely be observed in young children or adolescents after receiving a blunt, high energy impact. These young patients often suffer life threatening injuries to the intestines, neural or vascular systems or severe injury of the urinary tract. In these scenarios, plain projection radiographic imaging often leads to an inconclusive diagnosis making computer tomography indispensable to plan the treatment strategy. These strategies vary and the optimal approach is a subject to dispute. A surgical treatment of these injuries should ensure an immediate primary stability to allow early ambulation. The following study reports a unique trauma pattern with an isolated bilateral SI dislocation without fracture of the posterior or anterior pelvic ring nor concomitant injuries. This rare injury is a consequence of a pure vertical shear impact. This case report describes a technical pitfall of the iliolumbar transfixation and a solution to the problem. A dorso-ventro-dorsal approach, which utilizes both iliolumbar transfixation and ventral bilateral double plating osteosynthesis will be presented.