Sacral Fracture Nonunion Treated by Bone Grafting through a Posterior Approach

Sang Yang Lee,Masahiro Kurosaka,Kotaro Nishida,Takahiro Niikura,Yoshitada Sakai,Masahiko Miwa,Ryosuke Kuroda

doi:10.1155/2013/932521

Abstract

Nonunion of a sacral fracture is a rare but serious clinical condition which can cause severe chronic pain, discomfort while sitting, and significant restriction of the level of activities. Fracture nonunions reportedly occur most often after nonoperative initial treatment or inappropriate operative treatment. We report a case of fracture nonunion of the sacrum and pubic rami that resulted from non-operative initial treatment, which was treated successfully using bone grafting through a posterior approach and CT-guided percutaneous iliosacral screw fixation combined with anterior external fixation. Although autologous bone grafting has been the gold standard for the treatment of pelvic fracture nonunions, little has been written describing the approach. We utilized a posterior approach for bone grafting, which could allow direct visualization of the nonunion site and preclude nerve root injury. By this procedure, we were able to obtain the healing of fracture nonunion, leading to pain relief and functional recovery.

Highlights

Great progress in trauma care systems during the past decade has resulted in an increased survival rate of injured patients with severe pelvic injuries [1,2,3]
Pelvic nonunion is usually treated with open reduction and internal fixation, excision of scar tissue, and autologous bone grafting [6, 9, 12,13,14,15]
We described a case of sacral fracture nonunion that resulted from non-operative initial treatment, which was treated successfully using bone grafting through a posterior approach and CT-guided percutaneous iliosacral screw fixation combined with anterior external fixation

Summary

Introduction

Great progress in trauma care systems during the past decade has resulted in an increased survival rate of injured patients with severe pelvic injuries [1,2,3]. Fracture nonunions reportedly occur most often after non-operative initial treatment or inappropriate operative treatment (such as use of an external fixator as the definitive treatment for unstable pelvic ring fractures) [5,6,7,8,9,10,11]. Pelvic nonunion is usually treated with open reduction and internal fixation, excision of scar tissue, and autologous bone grafting [6, 9, 12,13,14,15]. We described a case of sacral fracture nonunion that resulted from non-operative initial treatment, which was treated successfully using bone grafting through a posterior approach and CT-guided percutaneous iliosacral screw fixation combined with anterior external fixation

Case Presentation

Discussion