J Korean Fract Soc.  2013 Jul;26(3):178-183. 10.12671/jkfs.2013.26.3.178.

Treatment of Unstable Sacral Fractures Related to Spino-Pelvic Dissociations

• Kim HS
• Lee JH
• Park KC
• Park YS

• KMID: 1431661
• DOI: http://doi.org/10.12671/jkfs.2013.26.3.178

Abstract

PURPOSE
To evaluate the outcomes of surgical treatment modality in unstable sacral fractures combined with spinal and pelvic ring injury depending on the presence of spino-pelvic dissociations.
MATERIALS AND METHODS
The subjects were 16 patients, with unstable sacral fractures combined with spinal and pelvic ring injuries, were operated from July 2004 to January 2011. The patients were divided into 2 groups depending on the presence of spino-pelvic dissociations: those with dissociations were group 1, and those without dissociations were group 2. Group 1 was treated with spino-pelvic fixations using iliac screw, while group 2 was treated with percutaneous iliosacral screw fixations. The availability of the radiological bony union with its application periods, and clinical results using visual analogue scale (VAS) and oswestry disability index (ODI) were evaluated, retrospectively.
RESULTS
Out of 16 patients, 8 patients in group 1 were treated with spino-pelvic fixation using iliac screw, and 8 patients in group 2 were treated with percutaneous iliosacral screw fixation. The mean bony union period was 17.4 weeks in group 1, and 19.6 weeks in group 2. The Mean VAS and ODI scores on the last follow-up were 2.5 points and 15.6 points in group 1, 2 points and 18.8 points in group 2, respectively. Both groups had favorable clinical results at the last follow-up.
CONCLUSION
For surgical treatments of unstable sacral fractures, spino-pelvic fixation using iliac screws is advised for cases with combined spino-pelvic dissociation, while percutaneous iliosacral screw fixation is advised for cases without combined dissociation.

Keyword

Sacral fracture; Spino-pelvic dissociation; Spino-pelvic fixation; Percutaneous iliosacral screw fixation; Iliac screw

MeSH Terms

Dissociative Disorders
Follow-Up Studies
Humans

Figure

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  Fig. 1 A 23-year-old male. Initial pelvis antero-posterior (AP) radiograph (A) and 3 dimentional computed tomography (3D CT) (B, C) demonstrate H-shaped sacral fracture (Denis zone 3) with spino-pelvic dissociation. Postoperative pelvis AP radiograph (D) demonstrates posterior stabilization of spino-pelvic fixation with iliac screw. The follow-up radiograph (E) and 3D CT (F) was obtained 20 weeks after operation demonstrates bony union and excellent clinical results.

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  Fig. 2 A 24-year-old female. Initial pelvis antero-posterior (AP) radiograph (A) and 3 dimentional computed tomography (B, C) demonstrate Denis zone 2 sacral fracture with pelvic ring injury and spinal fracture. Postoperative pelvis AP radiograph (D) demonstrates posterior stabilization of percutaneous fixation with iliosacral screw and anterior stabilization by reconstruction plating. The follow-up radiograph (E) was obtained 20 weeks after operation demonstrates bony union and excellent clinical results.

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