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Lumbopelvic Fixation with Bridged Distal Iliac Screws for Vertically Unstable Sacral Fractures

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Abstract

Purpose

The purpose of this study is to evaluate preliminary outcomes of vertically unstable sacral fractures treated by lumbopelvic fixation (LPF) augmented transiliac bridged screws.

Methods

From April 2017 to December 2019, fifteen consecutive patients with vertically unstable sacral fractures who had undergone LPF augmented transiliac bridged screws were enrolled. The radiological assessment included standard lumbopelvic x-rays and pelvic computed tomography (CT) to evaluate the lumbosacral angle (LSA), sacral kyphosis angle (SKA), lumbar lordosis angles (LLA) and Matta’s reduction criterias (MRC). Clinical and neurologic impairment outcomes were evaluated by the Majeed grading scale (MGS) and Gibbons criterias, respectively.

Results

All patients were followed for an average of 18 months (range, 14–25). All sacral fractures eventually healed and implant failure did not occur in any patient, though there were two patients with a loss of reduction (< 5 mm) during the follow-up period. According to the MRC, the results were excellent on 14 sides, good on five sides, and fair on one side. The MGS mean score was 82 points (range, 49–98 points); the results were excellent in nine cases, good in four cases, and fair in two cases. There was no statistically significant difference in SKA and LLA in preoperative and postoperative final controls. The preoperative and postoperative LSA were 72 ± 13.9 and 44.1 ± 11.3, respectively, and a statistically significant improvement was observed (p = 0.01).

Conclusion

In vertically unstable sacrum fractures, we believe that LPF augmented with transiliac bridging technique may expedite the reduction of vertical sacrum fracture and offers a reinforced fixation choice.

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Change history

  • 04 September 2022

    Several typographical errors have been corrected throughout the article and grammar has been improved.

References

  1. Tornetta, P., 3rd., & Matta, J. M. (1996). Outcome of operatively treated unstable posterior pelvic ring disruptions. Clinical Orthopaedics and Related Research, 329, 186–193.

    Article  Google Scholar 

  2. Khaled, S. A., Soliman, O., & Wahed, M. A. (2015). Functional outcome of unstable pelvic ring injuries after iliosacral screw fixation: single versus two screw fixation. European Journal of Trauma and Emergency Surgery, 41, 387–392.

    Article  CAS  Google Scholar 

  3. Giannoudis, P. V., Tzioupis, C. C., Pape, H. C., & Roberts, C. S. (2007). Percutaneous fixation of the pelvic ring: an update. Journal of Bone and Joint Surgery. British Volume, 89, 145–154.

    Article  CAS  Google Scholar 

  4. Kim, J. W., Oh, C. W., Oh, J. K., Kyung, H. S., Park, K. H., & Yoon, S. D. (2016). Yoon SH (2016) The incidence of and factors affecting iliosacral screw loosening in pelvic ring injury. Archives of Orthopaedic and Trauma Surgery, 136(7), 921–927. https://doi.org/10.1007/s00402-016-2471-3

    Article  PubMed  Google Scholar 

  5. Griffin, D. R., Starr, A. J., Reinert, C. M., Jones, A. L., & Whitlock, S. (2006). Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? Journal of Orthopaedic Trauma, 20(Suppl), S30–S36.

    Article  Google Scholar 

  6. Keating, J. F., Werier, J., Blachut, P., Broekhuyse, H., Meek, R. N., & O’Brien, P. J. (1999). Early fixation of the vertically unstable pelvis: the role of iliosacral screw fixation of the posterior lesion. Journal of Orthopaedic Trauma, 13, 107–113.

    Article  CAS  Google Scholar 

  7. Matta, J. M., & Saucedo, T. (1989). Internal fixation of pelvic ring fractures. Clinical Orthopaedics and Related Research, 242, 83–97.

    Article  Google Scholar 

  8. Suzuki, T., Hak, D. J., Ziran, B. H., Adams, S. A., Stahel, P. F., Morgan, S. J., & Smith, W. R. (2009). Outcome and complications of posterior transiliac plating for vertically unstable sacral fractures. Injury, 40, 405–409.

    Article  Google Scholar 

  9. Krappinger, D., Larndorfer, R., Struve, P., Rosenberger, R., Arora, R., & Blauth, M. (2007). Minimally invasive transiliac plate osteosynthesis for type C injuries of the pelvic ring: a clinical and radiological follow-up. Journal of Orthopaedic Trauma, 21, 595–602.

    Article  Google Scholar 

  10. Sagi, H. C. (2009). Technical aspects and recommended treatment algorithms in triangular osteosynthesis and spinopelvic fixation for vertical shear transforaminal sacral fractures. Journal of Orthopaedic Trauma, 23, 354–360.

    Article  Google Scholar 

  11. Schildhauer, T. A., Josten, C., & Muhr, G. (1998). Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. Journal of Orthopaedic Trauma, 12, 307–314.

    Article  CAS  Google Scholar 

  12. Sagi, H. C., Militano, U., Caron, T., & Lindvall, E. (2009). A comprehensive analysis with minimum 1-year follow-up of vertically unstable transforaminal sacral fractures treated with triangular osteosynthesis. Journal of Orthopaedic Trauma, 23, 319–321.

    Article  Google Scholar 

  13. Shinohara, K., Takigawa, T., Tanaka, M., Sugimoto, Y., Arataki, S., Ito, Y., & Ozaki, T. (2016). Biomechanical comparison of posterior fixation using spinal instrumentation and conventional posterior plate fixation in unstable vertical sacral fracture. Acta Medica Okayama, 70, 97–10.

    PubMed  Google Scholar 

  14. Tile, M. (1996). Acute pelvic fractures: I causation and classification. Journal of American Academic of Orthopedics Surgeons., 4(3), 143.

    Article  CAS  Google Scholar 

  15. Denis, F., Davis, S., & Comfort, T. (1988). Sacral fractures: An important problem. Retrospective analysis of 236 cases. Clinical Orthopaedics and Related Research, 227, 67–81.

    Article  CAS  Google Scholar 

  16. Matta, J. M., & Tornetta, P. (1996). Internal fixation of unstable pelvic ring injuries. Clinical Orthopaedics, 329, 129–140.

    Article  Google Scholar 

  17. Gibbons, K. J., Soloniuk, D. S., & Razack, N. (1990). Neurological injury and patterns of sacral fractures. Journal of Neurosurgery, 72, 889–893.

    Article  CAS  Google Scholar 

  18. Majeed, S. A. (1989). Grading the outcome of pelvic fracture. Journal of Bone and Joint Surgery. British Volume, 71, 304–306.

    Article  CAS  Google Scholar 

  19. Koshimune, K., Ito, Y., Sugimoto, Y., Kikuchi, T., Morita, T., Mizuno, S., & Ozaki, T. (2016). Minimally Invasive Spinopelvic Fixation for Unstable Bilateral Sacral Fractures Clin Spine Surg, 29(3), 124–127.

    PubMed  Google Scholar 

  20. Mehta, S., Auerbach, J., Born, C., & Chin, K. (2006). Sacral fractures. Journal of American Academy of Orthopaedic Surgeons, 14, 656–665.

    Article  Google Scholar 

  21. Reilly, M., Zinar, D., & Matta, J. M. (1996). Neurologic injuries in pelvic ring fracture. Clin Orthop Rel Res, 329, 28–36.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopeadics and Traumatology, University of Health Sciences, Umraniye Education and Research Hospital, Istanbul, Turkey

    Güray Altun, Ömer Polat, Çağrı Özcan & Bekir Yavuz Uçar

  2. Department of Orthopeadics and Traumatology, University of Health Sciences, Sultan 2. Abdulhamid Han Education and Research Hospital, Istanbul, Turkey

    Seyit Ali Gümüştaş

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  1. Güray Altun
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  2. Ömer Polat
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  3. Çağrı Özcan
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  4. Seyit Ali Gümüştaş
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  5. Bekir Yavuz Uçar
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Correspondence to Güray Altun.

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The authors declare that they have no conflict of interest.

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This study was approved by the Ethics Committee of the University Hospital. Decision date: 18/04/2020 Number: 54132726.

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Altun, G., Polat, Ö., Özcan, Ç. et al. Lumbopelvic Fixation with Bridged Distal Iliac Screws for Vertically Unstable Sacral Fractures. JOIO 56, 1992–1997 (2022). https://doi.org/10.1007/s43465-022-00714-4

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  • DOI: https://doi.org/10.1007/s43465-022-00714-4

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