Abstract
Background Data: Sacral fractures constitute a major entity of pelvic fractures. 50% of these sacral fractures are not recognized on initial physical examination of the traumatized patients. The most important prognostic factor in management of sacral fractures is the presence or absence of neurological deficit. Some studies adopt the concern regarding fixation of sacral fractures in poly-traumatized patients to avoid systemic effects and complications of recumbency. Purpose: Evaluation of the efficacy and safety of the minimally invasive percutaneous ilio-sacral fixation technique in management of initial twenty cases of sacral fractures at department of Neurosurgery in Alexandria University. Study Design: Retrospective clinical case cohort study. Patients and Methods: Between March 2017 and January 2019; 20 patients were presented at Neurosurgery Department in Alexandria University hospitals with traumatic sacral fractures. They were 13 males and 7 females with the mean of 34 years (ranged from 18-55 years). Plain X ray of pelvis including antero-posterior, inlet and outlet views of pelvis, CT scan with 3D reconstructions were done. We used Dennis classification and Roy-Camille classification in our study. Stabilization of sacral fracture was done percutaneously using 7 mm cannulated partially threaded ilio-sacral screws. Clinical, neurologic and radiographic examinations were performed in the follow up period (6 months) to assess healing, evaluate clinical improvement and to detect any implant changes. Results: Total 39 percutaneous ilio-sacral screws were placed in 20 patients. Partially threaded cancellous 7.0-millimeter cannulated screws were used. Fifteen patients had unilateral double screws; one patient had unilateral triple screws; two patients had bilateral single screws for bilateral sacral fracture and two patients had unilateral single screw. Two Misplaced screws out of thirty-nine screws were found in the post-operative CT. One patient developed post-operative foot drop. All fractures healed clinically and radio-graphically except one case fixed by single screw and did not show radiological healing. Conclusion: Percutaneous ilio-sacral fixation for sacral fractures is a safe minimally invasive method for management of sacral fractures. It is effective regarding pain relief with high fusion rate. It needs a long learning curve. Single screw fixation is not a rigid fixation and may lead to hardware failure. (2019ESJ193)
Highlights
Sacral fractures constitute a major entity of pelvic fractures and range from 5% as an isolated fracture up to 54% in concomitant with other pelvic ring injuries.[13]
We presented our results and evaluated the efficacy and safety of the percutaneous iliosacral fixation technique in management of the initial twenty cases operated at Neurosurgery Department in Alexandria University
Total 39 percutaneous ilio-sacral screws were placed in 20 patients (Table 3)
Summary
Sacral fractures constitute a major entity of pelvic fractures and range from 5% as an isolated fracture up to 54% in concomitant with other pelvic ring injuries.[13]. Egy Spine J - Volume 33 - January 2020 decompression if indicated.[15] Minimally invasive percutaneous ilio-sacral fixation technique is associated with some reported complications like hardware screw failure, iatrogenic neural injury, misplaced screws and incomplete reductions.[30] In this study, we presented our results and evaluated the efficacy and safety of the percutaneous iliosacral fixation technique in management of the initial twenty cases operated at Neurosurgery Department in Alexandria University. Type 3 Roy Camille fractures were excluded from the study because of failure of closed reduction and were operated by open lumbo-pelvic techniques (Table 1, 2). A cannulated drill was introduced under the guidance of the lateral, pelvic inlet and pelvic outlet views through the same osseous trajectory of the guide wire. Score >85 was considered excellent, 70 to 84 good, 55 to 69 fair and
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