From the Research
For a patient with a broken trans-sacroiliac screw identified on X-ray, the primary care physician should promptly refer the patient to the orthopedic surgeon or spine specialist who performed the original procedure within 1-2 weeks, or sooner if the patient is experiencing new or worsening pain, as supported by the most recent study 1. The referral should occur promptly to prevent further complications, such as instability at the sacroiliac joint, potentially causing pain, functional limitations, and in severe cases, neurological symptoms. While awaiting specialist evaluation, the PCP should manage pain with appropriate analgesics, such as:
- Acetaminophen 500-1000mg every 6 hours
- NSAIDs like ibuprofen 400-600mg every 6-8 hours, if not contraindicated, as these medications can help alleviate pain and discomfort associated with the broken screw. Activity modification should be recommended, including:
- Avoiding heavy lifting (>10 pounds)
- Avoiding high-impact activities, to prevent further stress on the affected area. The PCP should also order additional imaging, such as a CT scan, to better evaluate the hardware failure and surrounding bone integrity, as this will provide valuable information for the orthopedic specialist to determine the best course of action. The orthopedic specialist will determine if revision surgery is necessary based on the patient's symptoms, functional status, and the extent of hardware failure, as reported in the study 2, which highlights the importance of prompt evaluation and treatment to prevent long-term complications.