Can Lumbopelvic Fixation Salvage Unstable Complex Sacral Fractures?

Abstract

Background Traditional screw or plate fixation options can be used to fix the majority of sacral fractures. However, these techniques are unreliable with dysmorphic upper sacral segments, U-fractures, osseous compression of neural elements, and previously failed fixation. Lumbopelvic fixation can potentially address these injuries but is a technically demanding procedure requiring spinal and pelvic fixation and it is unclear whether it reliably corrects the deformity and restores function.Questions/purposes We therefore assessed reduction quality and loss of fixation, pain related to prominent hardware, subjective dysfunction measured by the Short Musculoskeletal Function Assessment (SMFA), and complications. Methods We retrospectively reviewed 15 patients with unstable sacral fractures treated with lumbopelvic fixation between 2002 and 2010. Patients had radiographic monitoring regarding reduction quality and loss of fixation and clinical followup using the SMFA. The minimum followup was 12 months (mean, 23 months; range, 12-41 months).

Minimal Invasive Surgical Treatment of Fragility Fractures of the Pelvis

“…The construct controls vertical instability, but locks the motion segment L5-S1 or L4-L5 and L5-S1. The best indications for lumbopelvic fixation are U-or H-shaped sacral fractures with intrusion of the lumbosacral spine into the small pelvis (55,56). The construct will prevent further displacement, which ultimately leads to neurological deficits such as urine or fecal incontinence.…”

Spinopelvic Fixation in Complex Sacral Fractures

“…Although, to our knowledge, there have been no large prospective studies comparing fixation methods for vertically unstable sacral fractures, multiple case series have been published demonstrating high union rates without secondary displacement from spinopelvic fixation for these fractures 3,11,[14][15][16][17] . Comparatively, the rate of secondary displacement is .20% when iliosacral screws are used in isolation for the treatment of complex sacral fractures [39][40][41] .…”

“…V ertically unstable and complex bilateral sacral fractures are a result of high-energy mechanisms that are often associated with other injuries [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . Vertically unstable sacral fractures result in the separation of the hemipelvis from the lumbar spine, whereas complex bilateral fractures result in a complete dissociation of the appendicular and axial skeleton.…”

“…Vertically unstable sacral fractures result in the separation of the hemipelvis from the lumbar spine, whereas complex bilateral fractures result in a complete dissociation of the appendicular and axial skeleton. Recently, the surgical treatment algorithm for these fractures has changed, with an increasing number of surgeons advocating for the use of spinopelvic fixation or triangular osteosynthesis, a combination of spinopelvic fixation along with sacroiliac or transsacral screw fixation, to increase the stability of the construct and to allow for early weightbearing with decreased concern for secondary displacement [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] .…”

Finite element analysis of breakage risk of two kinds of sacroiliac screws in unilateral sacral fractures

“…A variety of methods for vertically unstable sacral injuries have been advocated, including transiliac rods 10, transiliac plates 11 , percutaneous iliosacral screws 12,13 , and spinopelvic instrumentation 14,15 . In the posterior pelvic ring injuries treatment, sacroiliac screw internal xation technology is commonly used 16 .…”