Delayed sacroiliac joint infection after robot-assisted percutaneous iliac screw fixation for tile type C2 pelvic fractures: A case report and literature review.

BackgroundPercutaneous iliosacral screw fixation has become the gold standard for surgical stabilization of acute pelvic ring disruptions with unstable posterior pelvic injuries. Wound infection is uncommon owing to shorter operative time, reduced soft-tissue damage, less blood loss, and lower infection rates. Delayed sacroiliac joint infection after robot-assisted percutaneous iliosacral screw fixation is even rarer.Case presentation: We report a case of delayed sacroiliac joint infection after robot-assisted percutaneous iliosacral screw fixation for a tile type C2 pelvic fracture. A 43-years-old man developed recurrent low back pain and intermittent low-grade fever that occurred 10 months postoperatively and lasted 2 months. Symptoms temporarily improved with anti-inflammatory treatment but subsequently worsened, accompanied with chills and high fever (body temperature up to 39.0°C). Computed tomography revealed bone erosion and screw loosening, and inflammatory markers were elevated. The patient underwent open debridement and removal of the screws, followed by implantation of vancomycin- and gentamicin-loaded calcium sulfate beads. Cultures were negative; however, frozen section and pathology confirmed acute and chronic inflammatory infiltrations. The patient responded well to antibiotics and achieved full recovery.ConclusionsDelayed sacroiliac joint infection after robot-assisted percutaneous iliosacral screw fixation is a rare complication. Diagnosis can be challenging owing to the presence of atypical symptoms and negative cultures. Open debridement with removal of fixation and targeted antibiotic therapy can result in successful outcomes.