Bilateral ilio-sacral screw fixation of sacroiliac joint using a single guidewire: a technical case report

Introduction: Bilateral sacroiliac joint (SIJ) disruption is an uncommon, unstable pelvic injury with high morbidity. Percutaneous SI screw fixation is a well-established treatment but typically requires separate guidewire passes, increasing operative time and radiation exposure. Case and Technique: We report a 22-year-old male with bilateral pubic rami fractures and bilateral SIJ disruptions. After reduction and fixation of anterior ring, a single guidewire was passed from the left to the right SIJ, and bilateral screws were inserted over it under fluoroscopic guidance. Results: Bilateral fixation was successfully achieved with correct screw placement, effective compression, and intact L5 nerve function. This approach reduced operative time and fluoroscopic exposure. Conclusion: Single-guidewire bilateral SIJ fixation is a simple, effective technique that decreases operative time and radiation exposure while ensuring safe, stable fixation. Careful fluoroscopic monitoring is essential, and the method is feasible in both obese and nonobese patients.