Surgical treatment of unstable pelvic injury with displaced sacral fractures.

Abstract

Objective To evaluate the surgical technique and functional results of displaced sacral fractures. Methods From September 2000 to September 2007, thirty-three patients of pelvic injuries with sacral fractures treated with operation were assessed. There were 5 type-B pelvic fractures, and 28 type-C fractures, according to the AO/OTA classification system. Sacral fractures were classified by Denis classification into type- I , type- II, and type-III in 13, 11, and 9 cases, respectively. The patients with neurological injuries were find in 23 cases. Fractures of sacrum were fixed with tension band transiliac plate osteosynthe-sis in 1 case; pedicle rod-screw system placed to the iliac crest posterior to the pelvis for transversal fixation in 10; vertical distraction fixation through L_(4,5), L_5S_1, and bilateral iliac crest in 16; iliosacral screws fixation in 3; sacral bars fixation in 2; and combination of iliosacral screws and sacral bars in 1. Techniques for neural decompression with laminotomy and neurolysis of cauda equina nerve intraoperatively in 11 cases, and with delayed neurolysis and foraminotomy in 2. Results All patients were followed up on an average of 27.3 months. Clinical outcome was rated excellent in 17 cases, good in 7, fair in 2 and poor in 7, according to the Majeed functional evaluation. The satisfaction rate of clinical effect for sacral fractures of Denis type- I , type- II, and type-III was 92.3%, 72.7%, and 44.4%, respectively. For the neural decompression patients, neurological injuries from sacral fractures were recovered of excellent in 6 cases, good in 4 and no changes in 3. But for nonoperative group, the degree of recovery viewed excellent in 6 cases, good in 1, and no changes in 3. Complications of surgical treatment included: deep infection in 2 cases; unsatisfactory reduction and lumbosacral pains in 2; transient exacerbation of injured neural function in 4; and delayed sacral nerve injuries in 3. Conclusion Surgical treatment is important for improving reduction of sacral fractures; combination of anterior and posterior pelvic ring fixation enhance the strength of internal fixation effectively; early neural decompression could be helpful to recovery of the neural function. Key words: Sacrum ;  Fractures ;  bone ;  Fracture fixation ;  internal ;  Treatment outcome ;