Abstract
BackgroundTreatment of vertically displaced sacral fracture can be difficult even for the expert traumatologist. Traditional reduction methods can show some limitations; we suggest a minimally invasive technique, which could be effective, tissue sparing and economic in terms of equipment needed.Materials and methodsOur retrospective study included 11 patients with average age of 40.2 years (range 24–59 years), with type C pelvic ring disruption with monolateral sacral fracture (C1.3), who underwent surgical treatment from April 2007 to March 2008 using the minimally invasive technique. Radiographic examination, using Matta’s criteria, was carried out pre-operatively, post-operatively and at least at 1 year after surgery. All patients were functionally evaluated using Majeed’s grading scale with mean follow-up time of 18.9 months (range 14–25 months).ResultsPre-operative displacements averaged 10.8 mm (range 7–21 mm); post-operative displacements averaged 5.4 mm (range 3–12 mm), with excellent or good reduction in 91% of cases. No major complications occurred. On functional evaluation, 82% of patients obtained good or excellent results.ConclusionThe minimally invasive reduction technique, requiring a limited surgical approach and a standard radiolucent table, is in our experience a satisfactory procedure for management of monolateral vertically displaced sacral fracture.
Highlights
A lot has been written about minimally invasive stabilization of sacral fractures with percutaneous ilio-sacral screws [1,2,3,4,5] or posterior sacral plates [6], but few articles give sufficient details on the reduction methods
Inclusion criteria were: 61-C1.3 fracture pattern according to the Orthopaedic Trauma Association (OTA) [11], availability of complete clinical and radiological documentation and a minimum 12-month follow-up time
AP, inlet and outlet view radiograms of the pelvis were taken for every patient and post-operative displacements were measured on all three views (Fig. 2); we considered the highest value as an index of quality of reduction according to Matta’s criteria [7]
Summary
A lot has been written about minimally invasive stabilization of sacral fractures with percutaneous ilio-sacral screws [1,2,3,4,5] or posterior sacral plates [6], but few articles give sufficient details on the reduction methods. The classic traction method is often insufficient to deal with these difficulties, because of its exclusively axial effect, the large force required and the need to fix the intact hemi-pelvis in a strong and safe manner Some of these problems seem to be solved by use of special pelvic frames [8, 9], and radiolucent traction tables are expensive devices, available only in few hospitals. Materials and methods Our retrospective study included 11 patients with average age of 40.2 years (range 24–59 years), with type C pelvic ring disruption with monolateral sacral fracture (C1.3), who underwent surgical treatment from April 2007 to March 2008 using the minimally invasive technique. 82% of patients obtained good or excellent results
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