Sacral Fracture Treatment With a Variation of the Lumbopelvic Fixation Technique

Abstract

Spinopelvic instability is an uncommon injury that is caused by high-energy traumas. Surgical treatment is used, in the majority of cases, to restore stability and enable early mobilization. Various stabilization techniques have been used in the treatment of spinopelvic instability, and lumbopelvic fixation (LPF) is currently the technique of choice due to its biomechanical superiority. One of its limitations is the fact that the technique does not directly address the lower sacral segment, permitting a residual kyphotic deformity. This deformity has been attributed to unsatisfactory outcomes, including late development of pelvic floor muscle defects and complications during childbirth. We report a case of a patient with spinopelvic instability due to sacral fracture, which was treated using a variation of the LPF technique, in which rods and screws originally developed for cervicothoracic fixation were adapted to correct sacral deformity in the sagittal plane. The upper sacral segment was reduced indirectly using hip extension and femoral traction manoeuvres, associated with distraction manoeuvres via rods. Bone reduction forceps were used to reduce the kyphotic deviation in the lower sacral fragment, enabling its fixation to the lumbopelvic rod and screws system. There were no complications of infection, suture dehiscence, or breakage of the implants, and at the end of the first year of follow-up, the sacral kyphosis was normal and radiographic consolidation was confirmed. Our technique provides a viable and promising alternative to traditional LPF, making it especially useful in fractures with accentuated deviations of the lower sacral fragment. Level of Evidence: 4.Type of study: Case series

Surgical Management of Aged Complex Sacral Injuries by Lumbopelvic Stabilization

“…Em 8 (50%) casos não ocorreu lesão neurológica, 1 (6,2%) indivíduo evoluiu com parestesia, 2 (12,5%) com paresia nos membros inferiores e 5 (31,3%) com disfunções esfincterianas. Entre os pacientes com comprometimento neurológico, 4…”

“…1 Approximately 60% of these fractures go unnoticed in the initial evaluation, 2 due to several factors, such as low incidence, a wide variety of presentations in the patterns of these injuries, greater importance given to associated injuries, absence of neurological motor deficit, as well as the difficulty of identifying lesions on anteroposterior (AP) radiography of the pelvis at the first appointment. 3,4 The delay in identifying these injuries, associated with the clinical commitment of patients and the limitation of material and technical resources in some trauma centers, mean that some cases of complex sacral fractures are treated late. 4,5 Old sacrum fractures, those with more than three weeks of evolution, still challenge orthopedic surgeons.…”

“…3,4 The delay in identifying these injuries, associated with the clinical commitment of patients and the limitation of material and technical resources in some trauma centers, mean that some cases of complex sacral fractures are treated late. 4,5 Old sacrum fractures, those with more than three weeks of evolution, still challenge orthopedic surgeons. 5,6 The surgical treatment of these lesions has a range of options.…”