Surgical treatment of complex Denis zone III sacral fractures

Abstract

Objective To investigate the surgical treatment of complex Denis zone Ⅲ sacral fractures. Methods A retrospective study was conducted on the 15 complex Denis zone Ⅲ sacral fractures which had been treated from June 2011 to September 2015 in our hospital. They involved 9 men and 6 women, with an average age of 28.8 years (from 15 to 55 years). There were 8 U-shaped, 6 H-shaped and 3 lambda fractures. By the Gibbons grading for the sacral nerve injury, 3 cases were rated preoperatively as grade Ⅱ, 5 cases as grade Ⅲ and 7 as grade Ⅳ. Of them, 10 received π-shaped lumbopelvic fixation and sacral decompression 2 weeks after injury, one had lumbosacral fixation and sacral decompression 6 days after injury, and 4 underwent only sacral decompression 3 months after injury when they presented with symptoms of neural injury after fracture malunion. Their sacral malformation angle, visual analogue scale and EQ-5d scale were compared between pre-operation and postoperation. Results The 15 cases were followed up for 9 to 47 months (average, 24.9 months). Their full-weight-bearing time ranged from 8 to 14 weeks (average, 9.9 months). All the incisions healed well without any infection, pressure sore, implant loosening or breakage. There was no significant difference between the preoperative angle of malformation (35.7°±5.0°, from 15° to 90°) and the postoperative value (27.9°±6.0°, from 8° to 90°) (t=1.003, P=0.324). Their VAS pain score decreased significantly from preoperative 7.0±0.3 to postoperative 1.9±0.2, and their EQ-5D score increased significantly from preoperative 0.20±0.03 to postoperative 0.79± 0.04 (P<0.05). The final follow-ups revealed more or less recovery of neural function in all the patients. Conclusions π-shaped lumbopelivic fixation is an effective treatment for complex Denis zone Ⅲ sacral fractures. Effective decompression and stable fixation are prerequisites for early neurological and functional recovery. Simple sacral decompression can effectively promote nerve recovery in patients with old complex Denis zone Ⅲ sacral fractures. Key words: Sacrum; Fractures, bone; Fracture fixation, internal