Treatment of unstable sacral fractures with percutaneous reconstruction plate internal fixation

Abstract

PURPOSE:To study the effects of percutaneous reconstruction plate internal fixation in the treatment of unstable sacral fractures. METHODS: Percutaneous reconstruction plate internal fixation was applied on 21 cases of unstable sacral fracture (15 males and six females, at age range of 16-65 years, mean 38.3 years) including four cases of Denis Zone I, 14 cases of Zone II and three cases of Zone III. In operation, an arc incision (about 3-5 cm long) was made along the iliac crest on the outside border of posterior superior iliac spine (PSIS) on both sides, and then the plate was transported from the wounded side to the opposite one through the subcutaneous tunnel. RESULTS:The mean incision length, operation time, intraoperative blood loss was 4.3cm, 45.2min, and 160.8ml respectively. All these patients were followed up for 12-33 months (average 16.3 months), which showed no incision infection, intraoperative neurovascular injury, internal fixation loose or breakage, disunion, or obvious lower limb length inequality. The function result was rated as excellent in six cases, good in 12 and fair in 3, with excellence rate of 85.7%, according to the Majeed scoring system. CONCLUSION: Percutaneous reconstruction plate internal fixation is an ideal surgical approach to unstable sacral fractures, as it is easy, safe, causing less trauma and fewer complications, and conducive to quicker recovery. Key words: Fracture Fixation, Internal. Reconstructive Surgical Procedures. Sacrum. RESUMO OBJETIVO:Estudar os efeitos da reconstrução percutânea com fixação de placa interna no tratamento de fraturas sacrais instáveis. MÉTODOS: A reconstrução percutânea com fixação de placa interna foi aplicada em 21 casos de fratura sacral instável (15 homens e seis mulheres, com idade variando entre 16 e 65 anos, média de 38,3 anos) incluindo quatro casos de Zona I de Denis, 14 casos de Zona II e três casos de Zona III. No ato operatório, uma incisão arqueada (cerca de 3 a 5cm de comprimento) foi feita ao longo da crista ilíaca na borda externa da espinha ilíaca supero-posterior (PSIS) em ambos os lados, e então a placa foi transportada do lado da ferida para o lado oposto através do túnel subcutâneo. RESULTADOS: O comprimento médio da incisão, tempo operatório e perda sanguínea intra-operatória foram, respectivamente, 4,3cm, 45,2min e 160,8ml. Todos estes pacientes foram acompanhados por 12 a 33 meses (média 16,3 meses), o que mostrou nenhuma infecção de ferida operatória, lesão neurovascular intraoperatória, perda da fixação interna ou quebra, desunião ou desigualdade nos comprimentos dos membros inferiores. O resultado funcional foi excelente em seis casos, bom em doze e falho em três, com taxa excelente de 85,7%, de acordo com o sistema de escore de Majeed. CONCLUSÃO: Reconstrução percutânea com fixação de placa interna é uma abordagem cirúrgica ideal para fraturas sacrais instáveis, sendo fácil e segura, causando menos trauma e poucas complicações, conduzindo a uma recuperação mais rápida. Descritores: Fixação Interna de Fratura...

Treatment of Vertically Unstable Sacral Fractures with Pelvic External Fixation and Skeletal Traction

“…Until recently, there have been no definite methods to accurately prove if the nerve roots are anatomical continuity. Therefore, many authors have suggested, only decompression of nerve roots is involved if debris or fragments compressed neural roots identified by CT scanning [4,11,28]. We support this viewpoint, so the sacral fractures in this case are excluded in our study and submitted to posterior operation.…”

“…Some of these fixation techniques can apply sufficiently rigid fixation and gain good results by direct reduction of fracture. However, these conventional posterior operation approaches have such disadvantages as long incisions, long exposure time, soft tissue complications and more blood loss [11]. For example, infection rates have been reported to 27% when using a posterior approach, due to the presence of soft tissue injuries around the pelvis represented by the Morel-Lavallee-lesion [4].…”

“…Many authors reported the indirect reduction could achieve the same excellent function result as the anatomical reduction [13,27]. Chen et al [11] reported excellence rate up to 85.7% according to the Majeed scoring system using indirect reduction and percutaneous internal fixation. In our study, complete or essential reduction of displaced fractures had been achieved.…”

Comparison of Curative Effects between Minimally Invasive Percutaneous Lag Screw Internal Fixation and Reconstruction Plate for Unstable Pelvic Fractures

“…9 According to a study, reconstruction plate internal fixation is a safe and effective way to treat unstable pelvic posterior ring fractures. 10 However, there are very few studies comparing the minimally invasive percutaneous lag screw internal fixation with reconstruction plate internal fixation in the treatment of unstable pelvic fractures.…”