Posterior approach in treating sacral fracture combined with lumbopelvic dissociation.

Abstract

Type III Denis fracture of the sacrum is rare clinically, constituting approximately 16% of all sacral fractures. Because it is often complicated with neurologic injuries, treatment is crucial and difficult. Several surgical options are available for the treatment of type III Denis sacral fracture with lumbopelvic dissociation. The authors report 21 patients admitted to the hospital from February 2002 to May 2012 who had type III Denis sacral fracture combined with lumbopelvic dissociation. All of the patients were treated with posterior sacral lamina decompression, sacral nerve root decompression, fracture reduction, an integrated lumbopelvic internal fixation system, and posterolateral fusion. The authors recorded pre- and postoperative complications, fracture reduction, bone graft healing, and improvements in neurologic function, according to the Gibbons grading standard. The average surgical time was 190 minutes (range, 170-210), and the average amount of intraoperative bleeding was 960 mL (range, 930-1500). No intraoperative complications occurred. Twelve patients had complete recovery of neurologic function; 5 patients showed great improvement except for foot drop and impaired lower limb sensation; and 4 patients showed no improvement in lower limb, bladder, and rectum function. Gibbons grade decreased from an average of 3.43±0.51 before surgery to 1.76±1.09 at the last follow-up. Deep infections were noted in 2 cases, and in 1 case, vertebral screw loosening was observed 1 year postoperatively. Surgical reduction with lumbopelvic fixation is an ideal method for treating type III Denis sacral fracture with neurologic injury and lumbopelvic dissociation.