SACRAL FRACTURE TREATMENT WITH A VARIATION OF THE LUMBOPELVIC FIXATION TECHNIQUE

Vinícius Magno Da Rocha,Antônio Eulalio Pedrosa Araujo Junior,João Antonio Matheus Guimarães,Diego Pinheiro Aguiar,André Luiz Loyelo Barcellos,Antônio Paulo De Olivaes Filho,Felipe Moura Carrasco

doi:10.1590/s1808-185120181701174141

Vinícius Magno Da Rocha, Antônio Eulalio Pedrosa Araujo Junior + Show 5 more

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https://doi.org/10.1590/s1808-185120181701174141

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Abstract

ABSTRACT Spinopelvic instability is an uncommon injury that is caused by high-energy traumas. Surgical treatment is used, in the majority of cases, to restore stability and enable early mobilization. Various stabilization techniques have been used in the treatment of spinopelvic instability, and lumbopelvic fixation (LPF) is currently the technique of choice due to its biomechanical superiority. One of its limitations is the fact that the technique does not directly address the lower sacral segment, permitting a residual kyphotic deformity. This deformity has been attributed to unsatisfactory outcomes, including late development of pelvic floor muscle defects and complications during childbirth. We report a case of a patient with spinopelvic instability due to sacral fracture, which was treated using a variation of the LPF technique, in which rods and screws originally developed for cervicothoracic fixation were adapted to correct sacral deformity in the sagittal plane. The upper sacral segment was reduced indirectly using hip extension and femoral traction manoeuvres, associated with distraction manoeuvres via rods. Bone reduction forceps were used to reduce the kyphotic deviation in the lower sacral fragment, enabling its fixation to the lumbopelvic rod and screws system. There were no complications of infection, suture dehiscence, or breakage of the implants, and at the end of the first year of follow-up, the sacral kyphosis was normal and radiographic consolidation was confirmed. Our technique provides a viable and promising alternative to traditional LPF, making it especially useful in fractures with accentuated deviations of the lower sacral fragment. Level of Evidence: 4.Type of study: Case series

Highlights

Sacral fractures with spinopelvic instability are rare, and are the result of high-energy trauma with axial overload through the sacrum.[1,2] The injury is characterized by the presence of two longitudinal fractures through the sacral foramina, in combination with a transverse fracture, and the association with brain or spinal cord traumas and/or cavity organ injuries, besides being common, are potentially serious and should be considered in the initial evaluation of the trauma.[1,2,3,4]Another important aspect is the high rate of underdiagnosis of spinopelvic instability.[5]
Various stabilization techniques have been used in the treatment of spinopelvic instability, and lumbopelvic fixation (LPF) is currently the technique of choice due to its biomechanical superiority
We report a case of a patient with spinopelvic instability due to sacral fracture, which was treated using a variation of the LPF technique, in which rods and screws originally developed for cervicothoracic fixation were adapted to correct sacral deformity in the sagittal plane

Summary

Introduction

Sacral fractures with spinopelvic instability are rare, and are the result of high-energy trauma with axial overload through the sacrum.[1,2] The injury is characterized by the presence of two longitudinal fractures through the sacral foramina, in combination with a transverse fracture, and the association with brain or spinal cord traumas and/or cavity organ injuries, besides being common, are potentially serious and should be considered in the initial evaluation of the trauma.[1,2,3,4] Another important aspect is the high rate of underdiagnosis of spinopelvic instability.[5] The panoramic radiography of the pelvis, used in the routine evaluation of patients with multiple trauma, is insufficient to identify fractures of the sacrum with spinopelvic instability. The pain originating from coexisting lesions can mask complaints coming from the sacropelvic region, contributing to underdiagnosis.[4]

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