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.

Citations

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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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A Case of Surgically Treated by Transperitoneal Approach in Delayed Neurological Deficit after Sacral Fracture: A Case Report: Young Soo Jang, Jong Seok Lee, Jae Hyuk Choi, Sung Ju Bae, Chan Il Bae; J Korean Fract Soc 2013;26(1):69-72. Published online January 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.1.69

Abstract PDF: This study reviews a case of sacral fracture with delayed onset neurological deficit that showed good results after decompressive surgery. The delayed neurological deficit appeared at 4 weeks after injury and it was treated with anterior decompression through transperitoneal approach. A 23-year-old woman was injured in a car accident and had bilateral pubic rami fractures and fractures of the sacral ala on the right side. She was treated with external fixation devices for approximately four weeks, but complained of pain and numbness. The dorsiflexion and plantalflexion of the right ankle was weakened and graded as grade 2. Preoperative pelvic and sacral radiographs, computed tomography, magnetic resonance imaging and electromyelography, and nerve conduction study were performed to identify the region of neurological deficit, and we decided to implement neurological decompression. By transperitoneal approach, we performed bone curratage and decompression around the region of sacral alar slope and S1 foramen. The pain and numbness of the right foot cleared up. Dorsiflexion and plantalflexion of the right ankle improved to grade 5. Anterior decompression by transperitoneal approach proved to bring satisfactory results in a patient, who presented delayed neurological deficit after sacral fracture.

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Treatment of pelvic bone fracture involving the sacrum and sacroiliac joint: Hui Taek Kim, Kyo Min Son, Sang Jin Cheon, Chong Il Yoo; J Korean Soc Fract 2001;14(3):313-322. Published online July 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.3.313

Abstract PDF

PURPOSE
To evaluate the usefulness of early posterior internal fixation(I/F) by cannulated cancellous screw(CCS) in unstable pelvic bone fractures involving the sacrum and sacroiliac joint.
MATERIALS AND METHODS
Sixteen cases were evaluated retrospectively. Classification according to the injury mechanism, using Young's criteria, was as follows: 7 anteroposterior compression, 4 lateral compression, 4 vertical shear and 1 combined mechanism. With respect to treatment, 9 cases were treated by combined anterior external fixation(E/F) and posterior I/F with CCS(7 cases) and transiliac rod(2 cases). Five cases were treated by anterior E/F only, and 2 cases were treated without surgery. We analyzed clinical results using Matta's criteria, and radiologic abnormalities.
RESULTS
The management by posterior I/F with CCS and transiliac rod including anterior E/F has shown superior clinical results(7 satisfactory, 2 unsatisfactory) over the management by only anterior E/F(1 satisfactory, 4 unsatisfactory) or conservative methods(2 unsatisfactory). The rate of malunion and nonunion was also low in the former method in the radiographic analysis.
CONCLUSION
Posterior I/F using CCS is an excellent surgical procedure in the treatment of unstable pelvic bone fracture due to its lessened invasiveness, early applicability, simple surgical technique and its direct effects on the prevention of several complications.

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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
Management of sacral fractures associated with spinal or pelvic ring injury
Ye-Soo Park, Seung-Wook Baek, Hong-Sik Kim, Ki-Chul Park
Journal of Trauma and Acute Care Surgery.2012; 73(1): 239. 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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