Evaluation of closed multi-axial screws iliosacral fixation system combined with posterior segmental spinal fixation for treatment of unstable sacral fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Zhong , MENG Weikun , LI Liang , TAN Zhen , GUO Qiang , LIU Lei , HUANG Fuguo ,  WANG Guanglin

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

WANG Guanglin, Email: wglfrank@163.com

Keywords：

Sacral fracture; pelvic fracture; closed multi-axial screws; lumbopelvic fixation

DOI：

10.7507/1002-1892.201608014

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the effectiveness of lumbopelvic fixation using the combination of closed multi-axial screws (CMAS) iliosacral fixation system and the posterior segmental spinal fixation for unstable sacral fractures. Methods Between January 2013 and November 2014, 25 patients (39 sides) with unstable sacral fractures were treated with lumbopelvic fixation using the combination of CMAS iliosacral fixation system and the posterior segmental spinal fixation. There were 17 males and 8 females, aged 19-55 years (mean, 33.9 years). The causes were traffic accident injury in 15 cases, falling injury from height in 8 cases, and crushing injury in 2 cases. The interval of injury and operation was 1-13 days (mean, 3.5 days). Fracture was classified as Denis type I in 2 sides, type II in 20 sides, and type III in 17 sides; nerve injury was rated as Gibbons grade I in 2 cases, grade II in 2 cases, grade III in 7 cases, and grade IV in 9 cases. The reduction quality was evaluated by Matta criterion, the clinical function outcome by Majeed, and nerve function by Gibbons criterion. Results The average operation time was 110 minutes (range, 80-150 minutes). The average blood loss was 570 mL (range, 250-1 400 mL). Superficial wound infection occurred in 2 patients, and was cured after debridement and antibiotic therapy. All patients were followed up for an average of 18 months (range, 15-22 months). Postoperative X-ray and CT examination showed clinical healing of sacral fractures at 8-12 weeks after operation (mean, 10 weeks). The mean removal time of internal fixation was 13 months (range, 12-20 months). No screw loosening and fracture, adhesion of internal fixation to surrounding tissue, and obvious electrolysis phenomenon occurred. According to Matta criterion, reduction was rated as excellent in 32 sides, good in 6 sides, fair in 1 side, and the excellent and good rate was 97.5%. According to Majeed functional scoring at last follow-up, the mean score was 84.7 (range, 64-98); the results were excellent in 18 cases, good in 5 cases, and fair in 2 cases, and the excellent and good rate was 92.0%. The nerve function was significantly improved when compared with preoperative one; nerve injury was rated as Gibbons grade I in 8 cases, grade II in 8 cases, grade III in 3 cases, and grade IV in 1 case. Conclusion Lumbopelvic fixation using the combination of CMAS iliosacral fixation system and the posterior segmental spinal fixation is a relatively effective fixation for unstable sacral fractures. Not only is the fracture fixation rigid for early full weight-bearing, but also nerve decompression can be performed which facilitates nerve function recovery.

Citation： HUANG Zhong, MENG Weikun, LI Liang, TAN Zhen, GUO Qiang, LIU Lei, HUANG Fuguo, WANG Guanglin. Evaluation of closed multi-axial screws iliosacral fixation system combined with posterior segmental spinal fixation for treatment of unstable sacral fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(3): 313-318. doi: 10.7507/1002-1892.201608014 Copy

1.	Yi C, Hak DJ. Traumatic spinopelvic dissociation or U-shaped sacral fracture: a review of the literature. Injury, 2012, 43(4): 402-408.
2.	Lehmann W, Hoffmann M, Briem D,et al. Management of traumatic spinopelvic dissociations: review of the literature. Eur J Trauma Emerg Surg, 2012, 38(5): 517-524.
3.	Mouhsine E, Wwttstein M, Schizas C,et al. Modified triangular posterior osteosynthesis of unstable sacrum fracture. Eur Spine J, 2006, 15(6): 857-863.
4.	Gibbons KJ, Soloniuk DS, Razack N. Neurological injury and patterns of sacral fractures. J Neurosurg, 1990, 72(6): 889-893.
5.	Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
6.	Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
7.	Hussin P, Chan CY, Saw LB,et al. U-shaped sacral fracture: an easily missed fracture with high morbidity. A report of two cases. Emerg Med J, 2009, 26(9): 677-678.
8.	Adelved A, Totterman A, Glott T,et al. Long-term functional outcome after traumatic lumbosacral dissociation. A retrospective case series of 13 patients. Injury, 2016, 47(7): 1562-1568.
9.	Chung HY, Suk KS, Lee HM,et al. Growing rod technique for the treatment of the traumatic spinopelvic dissociation: a technical trick. Spine J, 2016, 16(3): e209-214.
10.	Yinger K, Scalise J, Olson SA,et al. Biomechanical comparison of posterior pelvic ring fixation. J Orthop Trauma, 2003, 17(7): 481-487.
11.	König MA, Jehan S, Boszczyk AA,et al. Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies. Euro Spine J, 2012, 21(5): 829-836.
12.	Gribnau AJ, van Hensvroek PB, Haverlag R,et al. U-shaped sacral fractures: surgical treatment and quality of life. Injury, 2009, 40(10): 1040-1048.
13.	Käch K, Trentz O. Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis. Unfallchirurg, 1994, 97(1): 28-38.
14.	Schildhauer TA, Ledoux WR, Chapman JR,et al. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma, 2003, 17(1): 22-31.
15.	Hu X, Pei F, Wang G,et al. Application triangular osteosynthesis for vertical unstable sacral fractures. Eur Spine J, 2013, 22(3): 503-509.
16.	Koshimunk K, Ito Y, Sugimoto Y,et al. Minimally Invasive Spinopelvic Fixation for Unstable Bilateral Sacral Fractures. Clin Spine Surg, 2016, 29(3): 124-127.
17.	Willams SK, Quinnan SM. Percutaneous Lumbopelvic Fixation for Reduction and Stabilization of Sacral Fractures With Spinopelvic Dissociation Patterns. J Orthop Trauma, 2016, 30(9): e318-324.
18.	Sagi HC, Militano U, Caron T,et al. A comprehensive analysis with minimum 1-year follow-up of vertically unstable transforaminal sacral fractures treated with triangular osteosynthesis. J Orthop Trauma, 2009, 23(5): 313-321.
19.	Reilly MC, Bono CM, Litkouhi B,et al. The effect of sacral fracture malreduction on the safe placement of iliosacral screws. J Orthop Trauma, 2003, 17(2): 88-94.

1. Yi C, Hak DJ. Traumatic spinopelvic dissociation or U-shaped sacral fracture: a review of the literature. Injury, 2012, 43(4): 402-408.
2. Lehmann W, Hoffmann M, Briem D,et al. Management of traumatic spinopelvic dissociations: review of the literature. Eur J Trauma Emerg Surg, 2012, 38(5): 517-524.
3. Mouhsine E, Wwttstein M, Schizas C,et al. Modified triangular posterior osteosynthesis of unstable sacrum fracture. Eur Spine J, 2006, 15(6): 857-863.
4. Gibbons KJ, Soloniuk DS, Razack N. Neurological injury and patterns of sacral fractures. J Neurosurg, 1990, 72(6): 889-893.
5. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
6. Majeed SA. Grading the outcome of pelvic fractures. J Bone Joint Surg (Br), 1989, 71(2): 304-306.
7. Hussin P, Chan CY, Saw LB,et al. U-shaped sacral fracture: an easily missed fracture with high morbidity. A report of two cases. Emerg Med J, 2009, 26(9): 677-678.
8. Adelved A, Totterman A, Glott T,et al. Long-term functional outcome after traumatic lumbosacral dissociation. A retrospective case series of 13 patients. Injury, 2016, 47(7): 1562-1568.
9. Chung HY, Suk KS, Lee HM,et al. Growing rod technique for the treatment of the traumatic spinopelvic dissociation: a technical trick. Spine J, 2016, 16(3): e209-214.
10. Yinger K, Scalise J, Olson SA,et al. Biomechanical comparison of posterior pelvic ring fixation. J Orthop Trauma, 2003, 17(7): 481-487.
11. König MA, Jehan S, Boszczyk AA,et al. Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies. Euro Spine J, 2012, 21(5): 829-836.
12. Gribnau AJ, van Hensvroek PB, Haverlag R,et al. U-shaped sacral fractures: surgical treatment and quality of life. Injury, 2009, 40(10): 1040-1048.
13. Käch K, Trentz O. Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis. Unfallchirurg, 1994, 97(1): 28-38.
14. Schildhauer TA, Ledoux WR, Chapman JR,et al. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma, 2003, 17(1): 22-31.
15. Hu X, Pei F, Wang G,et al. Application triangular osteosynthesis for vertical unstable sacral fractures. Eur Spine J, 2013, 22(3): 503-509.
16. Koshimunk K, Ito Y, Sugimoto Y,et al. Minimally Invasive Spinopelvic Fixation for Unstable Bilateral Sacral Fractures. Clin Spine Surg, 2016, 29(3): 124-127.
17. Willams SK, Quinnan SM. Percutaneous Lumbopelvic Fixation for Reduction and Stabilization of Sacral Fractures With Spinopelvic Dissociation Patterns. J Orthop Trauma, 2016, 30(9): e318-324.
18. Sagi HC, Militano U, Caron T,et al. A comprehensive analysis with minimum 1-year follow-up of vertically unstable transforaminal sacral fractures treated with triangular osteosynthesis. J Orthop Trauma, 2009, 23(5): 313-321.
19. Reilly MC, Bono CM, Litkouhi B,et al. The effect of sacral fracture malreduction on the safe placement of iliosacral screws. J Orthop Trauma, 2003, 17(2): 88-94.

Chinese Journal of Reparative and Reconstructive Surgery

Evaluation of closed multi-axial screws iliosacral fixation system combined with posterior segmental spinal fixation for treatment of unstable sacral fractures

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content