Journal of Musculoskeletal Trauma

Spino-Pelvic Fixation in Unstable Sacral Fracture: A Case Report: Jung Hwan Choi, Kyu Tae Hwang, Seung Gun Lee, Chang Nam Kang; J Korean Fract Soc 2018;31(4):145-148. Published online October 31, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.4.145

Abstract PDF: A 22-year-old female patient visited the emergency room (ER) after a pedestrian traffic accident in a drunken state. An examination at the ER revealed fractures at the right side of the sacral ala, sacral foramina, left anterior acetabulum, right inferior ramus, and right superior articular process of S1. She underwent spino-pelvic fixation and iliosacral (IS) screw fixation. One year later, bone union was completed and implant removal was performed and the treatment was completed without complications. The authors recommend spino-pelvic fixation and IS screw fixation for unstable sacral fractures as one of the excellent methods for obtaining posterior stability of the pelvis among the various treatments of unstable sacral fractures.

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Treatment of Unstable Sacral Fractures Related to Spino-Pelvic Dissociations: Hong Sik Kim, Jung Hwan Lee, Ki Chul Park, Ye Soo Park; J Korean Fract Soc 2013;26(3):178-183. Published online July 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.3.178

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.

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Integrative Korean Medicine Treatment for Sacral Fracture: Two Clinical Cases
Yeon Soo Kang, Pil Je Park, So Jeong Kim, Hyun Jin Jang, Min Ju Kim, Hyeon Kyu Choi, Jeong Kyo Jeong, Ju Hyun Jeon, Young Il Kim
Journal of Acupuncture Research.2023; 40(3): 281. CrossRef
Spino-Pelvic Fixation in Unstable Sacral Fracture: A Case Report
Jung-Hwan Choi, Kyu-Tae Hwang, Seung Gun Lee, Chang-Nam Kang
Journal of the Korean Fracture Society.2018; 31(4): 145. CrossRef

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Operative Treatment of Unstable Pelvic Ring Injury: Sang Hong Lee, Sang Ho Ha, Young Kwan Lee, Sung Won Cho, Sang Soo Park; J Korean Fract Soc 2012;25(4):243-249. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.243

Abstract PDF

PURPOSE
To analyze the clinical and radiological results of the different fixation methods according to the type and displacement of unstable pelvic ring injuries.
MATERIALS AND METHODS
Twenty-three patients with unstable pelvic ring injuries from January 2005 to December 2009 were classified according to the AO/OTA classification system. When patients had been diagnosed with unstable pelvic ring injuries with partial instability, they were treated by anterior fixation with a plate and posterior percutaneous iliosacral screw fixation. When patients had been diagnosed with unstable pelvic ring injuries with complete instability, they were treated by open reduction and anterior to posterior fixation with a plate through the ilioinguinal approach. The radiological results were evaluated using Matta and Saucedo's method, and the clinical results were evaluated using Rommens and Hessmann's method.
RESULTS
The outcomes from the radiological evaluation were that the displacement of the posterior pelvic ring were improved by about 6.65 mm in unstable pelvic ring injuries with partial instability. The displacement of the posterior pelvic ring were improved by about 7.8 mm in unstable pelvic ring injuries with complete instability. The clinical results were excellent in 13 cases and good in 6 cases on latest follow-up.
CONCLUSION
Good results can be achieved by selecting the treatment method according to the type of unstable pelvic ring injurie and displacement.

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Functional outcomes in pelvic fractures and the factors affecting them– A short term, prospective observational study at a tertiary care hospital
Subhajit Ghosh, Sameer Aggarwal, Prasoon Kumar, Vishal Kumar
Journal of Clinical Orthopaedics and Trauma.2019; 10(5): 896. CrossRef
Outcome of Surgical Treatment of AO Type C Pelvic Ring Injury
Do Hyeon Moon, Nam Ki Kim, Jun Sung Won, Jang Seok Choi, Dong Hyun Kim
Hip & Pelvis.2014; 26(4): 269. CrossRef
Minimally Invasive Plate Osteosynthesis for Humeral Proximal or Distal Shaft Fractures Using a 3.5/5.0 Metaphyseal Locking Plate
Hyoung Keun Oh, Suk Kyu Choo, Jung Il Lee, Dong Hyun Seo
Journal of the Korean Fracture Society.2012; 25(4): 305. CrossRef

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Upper Sacral Morphology Related to Iliosacral Screw Fixation in Korean: Jung Jae Kim, Chul Young Jung, Hyoung Keun Oh, Byoung Se Yang, Jae Suck Chang; J Korean Fract Soc 2007;20(2):115-122. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.115

Abstract PDF

PURPOSE
To evaluate upper sacral morphology and anatomy of safe zone related to iliosacral screw fixation in Korean.
MATERIALS AND METHODS
100 patients performed pelvis 3D CT scan were evaluated. We used 16 channel CT and analyzed reconstructed image (shaded-surface display, transparent image and reformat image).
RESULT
The angle between superior aspect of S1 body and iliac cortical density is 27.3Â°, between anterior cortical line of S1,2 body and horizontal plane 24.6Â°, and between superior aspect of S1 body and horizontal plane is 39.7Â°. The axis of S1, S2 pedicle is 32.5Â° and 15.6Â° toward anteromedial. The area of S1 pedicle according to sagittal plane and sagittal-oblique axis is 310.7 mm2 and 384.8 mm2. Also, S2 pedicle area is increased 163.1 mm2 to 188.4 mm2. The average depth of ala indentation is 5.1 mm and the maximal value is 9.5 mm. Distinct upper sacral dysplasia is 22%, transitional form is 32%.
CONCLUSION
We measured Korean upper sacrum with 3D-CT, found out dysplasia come up to 54%. Considering the frequency of dysplasia, the investigation of anatomy and technique is essential to sacroiliac screw insertion.

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Percutaneous posterior transiliac plate versus iliosacral screw fixation for posterior fixation of Tile C-type pelvic fractures: a retrospective comparative study
Chul-Ho Kim, Jung Jae Kim, Ji Wan Kim
BMC Musculoskeletal Disorders.2022;[Epub] CrossRef
Measurement of Optimal Insertion Angle for Iliosacral Screw Fixation Using Three-Dimensional Computed Tomography Scans
Jung-Jae Kim, Chul-Young Jung, Jonathan G. Eastman, Hyoung-Keun Oh
Clinics in Orthopedic Surgery.2016; 8(2): 133. CrossRef

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Radiologic Evaluation for the Safe Zone of Percutaneous Iliosacral Screw Fixation: Jong Keon Oh, Su Young Bae, Jong Oh Kim, Kwon Jae Roh, Jeong Joon Lee, Sang Yeol Chang; J Korean Soc Fract 2002;15(3):336-341. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.336

Abstract PDF

PURPOSE
To evaluate the correlation of the safe zone of percutaneous iliosacral screw fixation with sacral dysmorphism and sacral alar slope variation.
MATERIALS AND METHODS
We studied the plain radiographs and the pelvic bone CT images of 52 patients. We reviewed each cases in terms of Routt 's dysmorphism and sacral alar slope variation(anterior, coplanar and posterior to inter-ICD line). We divided each cases into narrow and wide groups by the width of safe zone for the transverse 6.5mm cannulated cancellous screw. The data were analysed by McNemar x2-test and Cochran Q-test(p<0.05).
RESULTS
Typical sacral dysmorphism was found in five cases(9%). Four cases with dysmorphism(80%) and eighteen non-dysmorphic cases(38.2%) revealed narrow safe zones. The sacral slopes were anterior in 16 cases, coplanar in 25 cases, and posterior in 11 cases. The safe zone was significantly narrow in the group with anterior slope variation.
CONCLUSION
We could not found definite correlation between sacral dysmorphism and a narrow safe zone because the incidence of dysmorphism was too low in our study which differed from Routt 's report. An anterior sacral alar slope on CT can be a significant risk indicator for potential narrow safe zone and the risk of screw malposition.

Citations

Citations to this article as recorded by

Measurement of Optimal Insertion Angle for Iliosacral Screw Fixation Using Three-Dimensional Computed Tomography Scans
Jung-Jae Kim, Chul-Young Jung, Jonathan G. Eastman, Hyoung-Keun Oh
Clinics in Orthopedic Surgery.2016; 8(2): 133. CrossRef
Operative Treatment of Unstable Pelvic Ring Injury
Sang Hong Lee, Sang Ho Ha, Young Kwan Lee, Sung Won Cho, Sang Soo Park
Journal of the Korean Fracture Society.2012; 25(4): 243. CrossRef
Upper Sacral Morphology Related to Iliosacral Screw Fixation in Korean
Jung-Jae Kim, Chul-Young Jung, Hyoung-Keun Oh, Byoung-Se Yang, Jae-Suck Chang
Journal of the Korean Fracture Society.2007; 20(2): 115. CrossRef

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