Technique for reduction and percutaneous fixation of U- and H-shaped sacral fractures

Ruatti, Sébastien; Kerschbaumer, Gaël; Gay, Emmanuel; Milaire, Michel; Merloz, P.; Tonetti, Jérôme

doi:10.1016/j.otsr.2013.03.025

Cited by 51 publications

(31 citation statements)

References 21 publications

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“…The present study aimed to show that closed reduction in a hyperextended supine position with manipulations and percutaneous TSTI/IS screw fixation is useful for treating Denis zone III sacral fractures. Currently, the present study is the largest case series regarding closed reduction and percutaneous screw fixation for these fractures [ 8 , 10 , 11 , 13 ]. Furthermore, the present study includes the greatest number of cases involving the supine position maneuver.…”

Section: Discussionmentioning

confidence: 99%

“…To minimize the risk of such complications, minimally invasive approaches have been increasingly used for these fractures. In recent reports, minimally invasive posterior screw fixations for pelvic ring fractures, including transsacral-transiliac (TSTI) and iliosacral (IS) screw fixations, have been reported to have a number of clinical and biomechanical advantages [ 9 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Closed Reduction in a “Hyperextended Supine Position” with Percutaneous Transsacral-Transiliac and Iliosacral Screw Fixation for Denis Zone III Sacral Fractures

Irifune

Hirayama

Takahashi

et al. 2018

Advances in Orthopedics

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Background Herein, we demonstrate the clinical results of closed reduction in a hyperextended supine position with transsacral-transiliac (TSTI) and iliosacral (IS) screw fixations for Denis zone III sacral fractures. Patients and Methods Sixteen consecutive patients with Denis zone III sacral fractures who were treated between January 2009 and September 2016 were evaluated. All patients were treated using percutaneous TSTI/IS screw fixation during closed reduction performed with patients placed in a hyperextended supine position with body manipulation. The clinical and radiological results were evaluated, and the neurological outcomes were retrospectively assessed using Gibbon's classification system. The clinical outcomes were evaluated using the German Multicenter Study Group Pelvic Outcome Scale (POS). Results The sacral kyphotic angle was reduced by 18.06° ± 15.26° (mean kyphotic angle: pre-OP, 39.44° ± 20.56°; post-OP, 21.38° ± 7.39°), and fracture translation was reduced by 5.93 ± 4.95 mm (mean fracture translation: pre-OP, 8.69 ± 8.03 mm; post-OP 2.75 ± 3.97 mm). The mean initial Gibbon's score was 3.00 ± 1.32. Among 15 patients with a follow-up duration of over 12 months, the mean reduction loss in the sacral kyphotic angle was 5.87° ± 10.40° and was 1.00 ± 3.00 mm for the fracture translation. The final Gibbon's score was 1.80 ± 1.21, and 73.3% of patients had good results based on the POS score. Conclusions Although closed reduction in a hyperextended supine position with percutaneous posterior screw fixation is associated with some surgical limitations and technical difficulties, the procedure is minimally invasive and highly effective for stabilizing Denis zone III sacral fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Closed Reduction in a “Hyperextended Supine Position” with Percutaneous Transsacral-Transiliac and Iliosacral Screw Fixation for Denis Zone III Sacral Fractures

Irifune

Hirayama

Takahashi

et al. 2018

Advances in Orthopedics

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“…The need for decompression of the spinal canal is another controversial issue in the surgical treatment of sacral fractures in general. 1,12,37,38 As a rule, we performed decompression in all unconscious patients or those with neurological deficits whenever there was impairment of the spinal canal or foraminal comminution. In the case presented here, performing adequate clinical evaluations was a particular challenge.…”

Section: Discussionmentioning

confidence: 99%

Sacral Fracture Treatment With a Variation of the Lumbopelvic Fixation Technique

et al. 2018

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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

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“…In 1993 the evolution of various imaging modalities lead to strictly percutaneous iliosacral screw fixation with the patient in supine position by Routt et al [8] Preoperative preparation consists of 1) Neurological examination [9] 2) Skeletal survey 3) CTscan (to rule out sacral dysplasia) [10] 4) Enema on the day of surgery (to clear the obscuring bowel shadows radiologically) Prior reduction of the posterior lesion using an external method (i.e. traction for vertical shear injuries and pelvic compression for open book injuries) is a prerequisite to iliosacral screw fixation [5] .Thorough familiarity with the anatomic features of lumbopelvic junction and neighbouring vessels and nerves is crucial [11] Guide wire should pass anterior to the sacral canal in Pennal's inlet view, superior to S1 neural foramen in Pennal's outlet view, and through the safe zone (23×12 mm.)…”

Section: Discussionmentioning

confidence: 99%

Percutaneous screw fixation for sacral & sacro iliac joint injuries: Case series

Ramprasath¹,

Thirunarayanan²,

S³

2017

Int. J. Orthop. Sci.

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Introduction: Management of poly trauma patients with pelvic ring injuries is a challenging situation where mobilization is a goal for early rehabilitation. Sacral fractures and sacroiliac joint injuries need to be addressed in these patients for starting early mobilization and rehabilitation and to achieve successful outcome. Materials and methods: A prospective study was conducted in our department involving 11 patients who were admitted following poly trauma with associated sacral and sacroiliac joint injuries. Denis & Weber classification for sacral fractures, and Tile/ Young and Burgess Class ification for SI joint disruption were used. We have performed percutaneous iliosacral screw fixation and achieved good functional outcome in these patients. Discussion: Thorough knowledge about anatomy of lumbopelvic junction and special radiographic views is mandatory. Prior reduction of the injuries involving sacrum and sacroiliac joint is mandatory before percutaneous fixation. Preoperative evaluation regarding neurological status and sacral dysplasia is the key for a successful outcome. Conclusion: With clearcut indications and contraindications, percutaneous iliosacral screw fixation appears to be one of the best techniques to achieve good fixation and early rehabilitation

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Technique for reduction and percutaneous fixation of U- and H-shaped sacral fractures

Cited by 51 publications

References 21 publications

Closed Reduction in a “Hyperextended Supine Position” with Percutaneous Transsacral-Transiliac and Iliosacral Screw Fixation for Denis Zone III Sacral Fractures

Closed Reduction in a “Hyperextended Supine Position” with Percutaneous Transsacral-Transiliac and Iliosacral Screw Fixation for Denis Zone III Sacral Fractures

Sacral Fracture Treatment With a Variation of the Lumbopelvic Fixation Technique

Percutaneous screw fixation for sacral & sacro iliac joint injuries: Case series

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