Spinopelvic Fixation in Complex Sacral Fractures

Schroeder, Gregory D.; Savage, Jason W.; Patel, Alpesh A.; Stover, Michael D.

doi:10.2106/jbjs.rvw.n.00007

Cited by 10 publications

(7 citation statements)

References 46 publications

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“…Moreover, in the case of fractures with lumbosacral instability, such as vertically unstable or complex bilateral sacral fractures, lumbopelvic fixation has become more prevalent, and this may require a multidisciplinary approach. 20,21 The current study found that years of surgeon experience did not significantly affect the operative indication for sacral fractures. This is similar to the thoracolumbar fracture literature, in which surgeon experience was not found to impact the operative indication of thoracolumbar fracture subtypes.…”

Section: Discussionmentioning

confidence: 54%

The Surgical Algorithm for the AO Spine Sacral Injury Classification System

Lee,

Lambrechts,

Narayanan

et al. 2024

Spine

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Study Design: Global cross-sectional survey. Objective: To establish a surgical algorithm for sacral fractures based on the AO Spine Sacral Injury Classification System. Summary of Background Data: Although the AO Spine Sacral Injury Classification has been validated across an international audience of surgeons, a consensus on a surgical algorithm has yet to be developed for sacral fractures by using the Sacral AO Spine Injury Score (Sacral AOSIS). Methods: A survey was sent to general orthopedic surgeons, orthopedic spine surgeons, and neurosurgeons across the five AO Spine regions of the world. Descriptions of controversial sacral injuries based on different fracture subtypes were given and surgeons were asked whether the patient should undergo operative or non-operative management. The results of the survey were used to create a surgical algorithm based on each subtypes’ Sacral AOSIS. Results: International agreement of 70% was decided on by the AO Spine Knowledge Forum Trauma experts to indicate a recommendation of initial operative intervention. Using this, sacral fracture subtypes of AOSIS 5 or greater were considered operative while those with AOSIS 4 or less were generally non-operative. For subtypes with an AOSIS of 3 or 4, if the sacral fracture was associated with an anterior pelvic ring injury (M3 case-specific modifier), intervention should be left to the surgeons’ discretion. Conclusion: The AO Spine Sacral Injury Classification System offers a validated hierarchical system to approach sacral injuries. Through multi-specialty and global surgeon input, a surgical algorithm was developed to determine appropriate operative indications for sacral trauma. Further validation is required, but this algorithm provides surgeons across the world with the basis for discussion and the development of standard of care treatment. Level of Evidence: Level IV.

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Section: Discussionmentioning

confidence: 54%

The Surgical Algorithm for the AO Spine Sacral Injury Classification System

Lee,

Lambrechts,

Narayanan

et al. 2024

Spine

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“…In der Folge wurden Ergebnisse nach Zementaugmentation dieser Fixateuranordnung auch bei instabilen Fragilitätsfrakturen beschrieben [48,49] stützung in Kombination mit einer TISV im Vergleich zur alleinigen TISV nachweisen. Zusätzlich konnten klinische Studien die Überlegenheit der lumbopelvinen Abstützung im Vergleich zur alleinigen TISV bei vertikaler Instabilität sowie bei komplexen bilateralen Sakrumfrakturen im Sinne von U-und H-Frakturen nachweisen [54], wobei diese Studien im Wesentlichen nur Patienten ohne Osteoporose nach Hochrasanztraumata einschlossen.…”

Section: Horizontale Fixateur-interne-stabilisierungenunclassified

“…Similarly, Acklin et al [53] reported considerable biomechanical advantages of lumbopelvic support in combination with ISF compared with ISF alone in patients with reduced bone quality. A clinical study demonstrated the superiority of lumbopelvic support compared with ISF alone in complex bilateral sacral U-and H-type fractures with vertically instability [54], although these studies essentially only included patients without osteoporosis after high-speed traumas.…”

Section: Lumbopelvic Vertebropelvic or Triangular Supportmentioning

confidence: 99%

Current Minimally Invasive Surgical Concepts for Sacral Insufficiency Fractures

Spiegl¹,

Schnake

Ullrich

et al. 2021

Z Orthop Unfall

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An increasing incidence of sacral insufficiency fractures in geriatric patients has been documented, representing a major challenge to our healthcare system. Determining the accurate diagnosis requires the use of sectional imaging, including computed tomography and magnetic resonance imaging. Initially, non-surgical treatment is indicated for the majority of patients. If non-surgical treatment fails, several minimally invasive therapeutic strategies can be used, which have shown promising results in small case series. These approaches are sacroplasty, percutaneous iliosacral screw fixation (S1 with or without S2), trans-sacral screw fixation or implantation of a trans-sacral bar, transiliac internal fixator stabilisation, and spinopelvic stabilisation. These surgical strategies and their indications are reported in detail. Generally, treatment-related decision making depends on the clinical presentation, fracture morphology, and attending surgeonʼs experience.

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“…Posteriormente, Roy-Camille descreveu o tipo III com traço transverso, conforme o mecanismo de trauma: flexão, extensão e cominutiva. Finalmente, as fraturas que envolvem ambos os lados do sacro podem ser classificadas conforme se assemelham a letras dos alfabetos latino e grego (U, T, H e λ [lambda]) 1,3,4 (►Figura 1). 5 Outra forma de classificar as fraturas do sacro é por meio da classificação Arbeitsgemeinschaft für Osteosynthesefragen (AO, "Associação para o Estudo da Fixação Interna", em alemão) Spine.…”

Section: Introductionunclassified

“…O tratamento cirúrgico pode ser realizado de diferentes formas: parafusos e placas sacrais, e, nos casos de fraturas complexas do sacro com instabilidade vertical, é necessário realizar estabilização cirúrgica entre a coluna lombar e a pelve com sistemas que oferecem maior estabilidade. 1,4 Na técnica de Schildhauer et al 7 para inserção do parafuso de osso ilíaco, a asa do ilíaco é exposta parcialmente. Após isso, é identificado o ponto de entrada do parafuso 1 cm abaixo da espinha ilíaca posterossuperior.…”

Section: Introductionunclassified

Fraturas complexas do sacro com dissociação espinopélvica tratadas cirurgicamente com fixação iliolombar

Miyamoto¹,

Graells

Sebben³

et al. 2020

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Analisar uma série de casos de fraturas complexas do sacro com dissociação espinopélvica tratados cirurgicamente com fixação iliolombar, e revisar a literatura médica existente. Métodos Para a análise, foram avaliados retrospectivamente os prontuários médicos de casos operados utilizando a técnica de Schildhauer et al para fixação. O período de acompanhamento foi de pelo menos 12 meses. Os resultados funcionais foram avaliados por meio da escala visual analógica (EVA) de dor e do índice de incapacidade de Oswestry, versão 2.0. Os dados foram comparados com os da literatura médica existente. Resultados Seis casos foram analisados, sendo que quatro evoluíram com incapacidade moderada, um, com incapacidade mínima, e um, com incapacidade grave. Três casos que apresentavam déficit neurológico obtiveram melhora significativa. Apenas um caso evoluiu com complicação tromboembólica pulmonar. Conclusão A técnica de Schildhauer et al é eficiente para a fixação de fraturas complexas de sacro com dissociação espinopélvica. Os pacientes evoluíram com bons resultados funcionais. A liberação precoce de sustentação de carga demonstrou-se segura com o uso deste tratamento.

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Spinopelvic Fixation in Complex Sacral Fractures

Cited by 10 publications

References 46 publications

The Surgical Algorithm for the AO Spine Sacral Injury Classification System

The Surgical Algorithm for the AO Spine Sacral Injury Classification System

Current Minimally Invasive Surgical Concepts for Sacral Insufficiency Fractures

Fraturas complexas do sacro com dissociação espinopélvica tratadas cirurgicamente com fixação iliolombar

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