Fractures of the pelvis

Repair of sacral fractures using pins and polymethylmethacrylate (six cases)

“…Stabilisation of vertebral fractures with pins and PMMA has been previously documented in the literature and L7–S1 composite fixation has been described for the stabilisation of L7 fractures and degenerative lumbosacral disease . However, in the comparatively small body of veterinary work pertaining to sacral fractures, most work has focussed on classification of fracture configuration .…”

“…Historically, the most commonly used technique for sacral fracture fixation in veterinary surgery has been the iliosacral lag screw . When used for simple longitudinal or oblique fractures, the inherent stability and interfragmentary compression created by one or two lag screws is anticipated to result in predictable primary bone healing.…”

“…Pin placement in a generally dorsal to ventral direction along the depth of the ilial wing results in a strong construct that can be attributed to the large length of the pin–bone interface. In this case series, pin size was dictated by the width of the ilial wing, with care not to exceed 25% of the ilial width, as per recommendations for long‐bone external skeletal fixation pin placement . Similarly, if used alone, placement of a minimum of three pins per side in longitudinal fractures and two in transverse fracture scenarios was attempted.…”

“…Although conservative treatment, typically consisting of a minimum 4–6 weeks' cage confinement coupled with appropriate analgesia and, potentially, external splintage, may be used in some cases, there are presently no guidelines in the literature detailing the indications for or the success rates of such an approach. As such, it seems logical to extrapolate from recommendations regarding vertebral fractures and sacroiliac luxation, whereby patients with an unstable fracture configuration, neurological deficits, severe displacement compromising pelvic canal or coxofemoral alignment, unmanageable pain or concurrent orthopaedic injuries are considered surgical candidates . Consequently, certain abaxial Anderson type I and type IV fractures may be amenable to conservative therapy, whereas most axial fractures will generally require surgical reduction and stabilisation.…”

“…The most widely used method of surgical stabilisation is an iliosacral lag screw, typically for fixation of unstable type I and type II sacral fractures, similar to routine sacroiliac luxation repair . However, without the use of intraoperative fluoroscopic guidance, the previously elucidated safe corridor for sacral implants can be easily missed, resulting in suboptimal implant placement .…”