Treatment of Unstable Sacral Fractures Related to Spino-Pelvic Dissociations

Hong-Sik Kim; Jung-Hwan Lee; Ki-Chul Park; Ye-Soo Park

doi:10.12671/jkfs.2013.26.3.178

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Kim, Lee, Park, and Park: Treatment of Unstable Sacral Fractures Related to Spino-Pelvic Dissociations

Original Article

Journal of the Korean Fracture Society 2013; 26(3): 178-183.

Published online: 15 July 2013

DOI: https://doi.org/10.12671/jkfs.2013.26.3.178

Treatment of Unstable Sacral Fractures Related to Spino-Pelvic Dissociations

Hong-Sik Kim, M.D., Jung-Hwan Lee, M.D., Ki-Chul Park, M.D., Ye-Soo Park, M.D., Ph.D.

Department of Orthopedic Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.

Address reprint requests to: Ye-Soo Park, M.D., Ph.D. Department of Orthopedic Surgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 471-701, Korea. Tel: 82-31-560-2316·Fax: 82-31-557-8781, hyparkys@hanyang.ac.kr

Received 1 August 2012 Revised 26 October 2012 Accepted 10 March 2013

(open-access):

This is anOpen Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the outcomes of surgical treatment modality in unstable sacral fractures combined with spinal and pelvic ring injury depending on the presence of spino-pelvic dissociations.

Materials and Methods

The subjects were 16 patients, with unstable sacral fractures combined with spinal and pelvic ring injuries, were operated from July 2004 to January 2011. The patients were divided into 2 groups depending on the presence of spino-pelvic dissociations: those with dissociations were group 1, and those without dissociations were group 2. Group 1 was treated with spino-pelvic fixations using iliac screw, while group 2 was treated with percutaneous iliosacral screw fixations. The availability of the radiological bony union with its application periods, and clinical results using visual analogue scale (VAS) and oswestry disability index (ODI) were evaluated, retrospectively.

Results

Out of 16 patients, 8 patients in group 1 were treated with spino-pelvic fixation using iliac screw, and 8 patients in group 2 were treated with percutaneous iliosacral screw fixation. The mean bony union period was 17.4 weeks in group 1, and 19.6 weeks in group 2. The Mean VAS and ODI scores on the last follow-up were 2.5 points and 15.6 points in group 1, 2 points and 18.8 points in group 2, respectively. Both groups had favorable clinical results at the last follow-up.

Conclusion

For surgical treatments of unstable sacral fractures, spino-pelvic fixation using iliac screws is advised for cases with combined spino-pelvic dissociation, while percutaneous iliosacral screw fixation is advised for cases without combined dissociation.

Keywords: Sacral fracture, Spino-pelvic dissociation, Spino-pelvic fixation, Percutaneous iliosacral screw fixation, Iliac screw

Figures and Tables

Fig. 1

A 23-year-old male. Initial pelvis antero-posterior (AP) radiograph (A) and 3 dimentional computed tomography (3D CT) (B, C) demonstrate H-shaped sacral fracture (Denis zone 3) with spino-pelvic dissociation. Postoperative pelvis AP radiograph (D) demonstrates posterior stabilization of spino-pelvic fixation with iliac screw. The follow-up radiograph (E) and 3D CT (F) was obtained 20 weeks after operation demonstrates bony union and excellent clinical results.

Fig. 2

A 24-year-old female. Initial pelvis antero-posterior (AP) radiograph (A) and 3 dimentional computed tomography (B, C) demonstrate Denis zone 2 sacral fracture with pelvic ring injury and spinal fracture. Postoperative pelvis AP radiograph (D) demonstrates posterior stabilization of percutaneous fixation with iliosacral screw and anterior stabilization by reconstruction plating. The follow-up radiograph (E) was obtained 20 weeks after operation demonstrates bony union and excellent clinical results.

Table 1

Comparison of Radiological and Clinical Results between the Group 1 and 2

Values are presented as mean±standard deviation. ODI: Oswestry disability index, VAS: Visual analogue scale.

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