Back
 SS  Vol.4 No.4 , April 2013
Treatment of Vertically Unstable Sacral Fractures with Pelvic External Fixation and Skeletal Traction
Abstract: Objective: To determine the efficacy in treatment of vertically unstable sacral fractures with pelvic external fixation and skeletal traction. Patients and Methods: The pelvic external fixation and skeletal traction were applied on 12 cases of vertically unstable sacral fracture (eight males and four females, at age of 19 - 52 years, mean 35.2 years) including two cases of Denis Zone I, nine of Zone II, and one of Zone III. All patients were treated with the pelvic external fixation, and pre- and post-operational longitudinal skeletal traction. Results: The mean operation time, skeletal traction time, skeletal traction removal time and full weight bearing time were 38 min, 4.5 weeks, 8.5 weeks, and 10.3 weeks respectively. All these patients were followed up for 12 - 36 months (average, 22.5 months), which showed no associated complication. The function results were rated as excellent in four cases, good in six and fair in two, with a mean score of 84.4 points, according to Majeed scoring system. Conclusion: The anterior pelvic external fixation with continuous skeletal traction can reliably restore and stabilize the vertically unstable sacrum fracture with excellent functional and radiographic outcomes. It is an ideal method to treat unstably vertical sacral fracture.
Cite this paper: X. Wu, H. Zhu, H. Du, W. Ma and C. Guo, "Treatment of Vertically Unstable Sacral Fractures with Pelvic External Fixation and Skeletal Traction," Surgical Science, Vol. 4 No. 4, 2013, pp. 225-230. doi: 10.4236/ss.2013.44043.
References

[1]   C. Lee, Y. S. Park, S. W. Baek, H. S. Kim and K. C. Park, “Management of Sacral Fractures Associated with Spinal or Pelvic Ring Injury,” The Journal of Trauma and Acute Care Surgery, Vol. 73, No. 1, 2012, pp. 239-242. doi:10.1097/TA.0b013e31825a79d2

[2]   V. A. Lykomitros, K. A. Papavasiliou, Z. M. Alzeer, F. E. Sayegh, J. M. Kirkos and G. A. Kapetanos, “Management of Traumatic Sacral Fractures: A Retrospective Case-Series Study and Review of the Literature,” Injury, Vol. 41, No. 3, 2010, pp. 266-272. doi:10.1016/j.injury.2009.09.008

[3]   G. Osterhoff, C. Ossendorf, G. A. Wanner, H. P. Simmen and C. M. Werner, “Posterior Screw Fixation in Rotationally Unstable Pelvic Ring Injuries,” Injury, Vol. 42, No. 10, 2011, pp. 992-996. doi:10.1016/j.injury.2011.04.005

[4]   T. Suzuki, D. J. Hak, B. H. Ziran, S. A. Adams, P. F. Stahel, S. J. Morgan and W. R. Smith, “Outcome and Complications of Posterior Transiliac Plating for Vertically Unstable Sacral Fractures,” Injury, Vol. 40, No. 4, 2009, pp. 405-409. doi:10.1016/j.injury.2008.06.039

[5]   G. Q. Tan, J. L. He, B. S. Fu, L. X. Li, B. M. Wang and D. S. Zhou, “Lumbopelvic Fixation for Multiplanar Sacral Fractures with Spinopelvic Instability,” Injury, Vol. 43, No. 8, 2012, pp. 1318-1325. doi:10.1016/j. injury.2012.05.003

[6]   H. C. Sagi, “Technical Aspects and Recommended Treatment Algorithms in Triangular Osteosynthesis and Spinopelvic Fixation for Vertical Shear Transforaminal Sacral Fractures,” Journal of Orthopaedic Trauma, Vol. 23, No. 5, 2009, pp. 354-360. doi:10.1097/BOT.0b013e3181a1143a

[7]   D. M. Sciubba, J. P. Wolinsky, K. D. Than, Z. L. Gokaslan, T. F. Witham and K. P. Murphy, “CT Fluoroscopically Guided Percutaneous Placement of Transiliosacral Rod for Sacral Insufficiency Fracture: Case Report and Technique,” American Journal of Neuroradiology, Vol. 28, No. 8, 2007, pp. 1451-1454. doi:10.3174/ajnr.A0665

[8]   F. Denis, S. Davis and T. Comfort, “Sacral Fractures: An Important Problem. Retrospective Analysis of 236 Cases,” Clinical Orthopaedics and Related Research, Vol. 227, 1988, pp. 67-81.

[9]   S. A. Majeed, “Grading the Outcome of Pelvic Fractures,” Journal of Bone and Joint Surgery, Vol. 71, No. 2, 1989, pp. 304-306.

[10]   P. R. Tornetta and J. M. Matta, “Outcome of Operatively Treated Unstable Posterior Pelvic Ring Disruptions,” Clinical Orthopaedics and Related Research, Vol. 329, 1996, pp. 186-193. doi:10.1097/00003086 -199608000-00022

[11]   H. W. Chen, G. D. Liu, S. Ou, G. S. Zhao and J. Pan, “Treatment of Unstable Sacral Fractures with Percutaneous Reconstruction Plate Internal Fixation,” Acta Cirúrgica Brasileira, Vol. 27, No. 5, 2012, pp. 338-342. doi:10.1590/S0102-86502012000500010

[12]   C. Bellabarba, T. A. Schildhauer, A. R. Vaccaro and J. R. Chapman, “Complications Associated with Surgical Stabilization of High-Grade Sacral Fracture Dislocations with Spino-Pelvic Instability,” Spine, Vol. 31, No. 11, 2006, pp. S80-S88.

[13]   M. A. Konig, U. Seidel, P. Heini, R. Orler, N. A. Quraishi, A. A. Boszczyk and B. M. Boszczyk, “Minimal-Invasive Percutaneous Reduction and Transsacral Screw Fixation for U-shaped Fractures,” Journal of Spinal Disorders & Techniques, Vol. 26, No. 1, 2011, pp. 48-54. doi:10.1097/BSD.0b013e3182318539

[14]   M. Rysavy, T. Pavelka, M. Khayarin and V. Dzupa, “Iliosacral Screw Fixation of the Unstable Pelvic Ring Injuries,” Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca, Vol. 77, No. 3, 2010, pp. 209-214.

[15]   S. B. Hu, H. Xu, H. B. Guo, T. Sun and C. J. Wang, “External Fixation in Early Treatment of Unstable Pelvic Fractures,” Chinese Medical Journal (English Edition), Vol. 125, No. 8, 2012, pp. 1420-1424.

[16]   P. Grubor, S. Milicevic, M. Biscevic and R. Tanjga, “Selection of Treatment Method for Pelvic Ring Fractures,” Medical Archives, Vol. 65, No. 5, 2011, pp. 278-282.

[17]   S. A. Majeed, “External Fixation of the Injured Pelvis. The Functional Outcome,” The Journal of Bone & Joint Surgery, Vol. 72, No. 4, 1990, pp. 612-614.

[18]   B. Gunterberg, I. Goldie and P. Slatis, “Fixation of Pelvic Fractures and Dislocations. An Experimental Study on the Loading of Pelvic Fractures and Sacro-Iliac Dislocations after External Compression Fixation,” Acta Orthopaedica Scandinavica, Vol. 49, No. 3, 1978, pp. 278-286. doi:10.3109/ 17453677809005765

[19]   M. J. Gardner, D. Kendoff, S. Ostermeier, M. Citak, T. Hufner, C. Krettek and S. E. Nork, “Sacroiliac Joint Compression Using an Anterior Pelvic Compressor: A Mechanical Study in Synthetic Bone,” Journal of Orthopaedic Trauma, Vol. 21, No. 7, 2007, pp. 435-441. doi:10.1097/BOT.0b013e318 126bb8e

[20]   W. Y. Kim, T. C. Hearn, O. Seleem, E. Mahalingam, D. Stephen and M. Tile, “Effect of Pin Location on Stability of Pelvic External Fixation,” Clinical Orthopaedics and Related Research, Vol. 316, 1999, pp. 237-244. doi:10.1097/00003086-199904000-00030

[21]   S. M. Tomic and N. S. Slavkovic, “Unstable Fractures of the Pelvis Treated by Ilizarov External Fixation Device,” Acta Chirurgica Iugoslavica, Vol. 57, No. 1, 2010, pp. 25-29. doi:10.2298/ACI1001025T

[22]   L. B. Solomon, A. P. Pohl, M. J. Chehade, A. M. Malcolm, D. W. Howie and M. Henneberg, “Surgical Anatomy for Pelvic External Fixation,” Clinical Anatomy, Vol. 21, No. 7, 2008, pp. 674-682. doi:10.1002/ca.20697

[23]   M. J. Gardner and S. E. Nork, “Stabilization of Unstable Pelvic Fractures with Supraacetabular Compression External Fixation,” Journal of Orthopaedic Trauma, Vol. 21, No. 4, 2007, pp. 269-273. doi:10.1097/BOT.0b013e318030e3e4

[24]   T. Taguchi, S. Kawai, K. Kaneko and D. Yugue, “Operative Management of Displaced Fractures of the Sacrum,” Journal of Orthopaedic Science, Vol. 4, No. 5, 1999, pp. 347-352. doi:10.1007/ s007760050115

[25]   D. C. Templeman, T. Simpson and J. M. Matta, “Surgical Management of Pelvic Ring Injuries,” Instructional Course Lectures, Vol. 54, 2005, pp. 395-400.

[26]   A. Gansslen, H. C. Pape, U. Lehmann, U. Lange, C. Krettek and T. Pohlemann, “Open Reduction and Internal Fixation of Unstable Sacral Fractures,” Zentralblatt für Chirurgie, Vol. 128, No. 1, 2003, pp. 40-45.

[27]   D. Schweitzer, A. Zylberberg, M. Cordova and J. Gonzalez, “Closed Reduction and Iliosacral Percutaneous Fixation of Unstable Pelvic Ring Fractures,” Injury, Vol. 39, No. 8, 2008, pp. 869-874.

[28]   M. A. Ayoub, “Vertically Unstable Sacral Fractures with Neurological Insult: Outcomes of Surgical Decompression and Reconstruction Plate Internal Fixation,” International Orthopaedics, Vol. 33, No. 1, 2009, pp. 261-267. doi:10.1007/s00264-007-0468-9

[29]   T. Niikura, S. Y. Lee, K. Oe, A. Koh, T. Koga, Y. Dogaki, E. Okumachi and M. Kurosaka, “Incidence of Venous thromboembolism in Pelvic and Acetabular Fractures in the Japanese Population,” Journal of Orthopaedic Science, Vol. 17, No. 3, 2012, pp. 233-238. doi:10.1007/s00776-012-0203-2

[30]   R. K. Sen, A. Kumar, S. K. Tripathy, S. Aggarwal, N. Khandelwal and S. R. Manoharan, “Risk of Postoperative Venous Thromboembolism in Indian Patients Sustaining Pelvi-Acetabular Injury,” International Orthopaedics, Vol. 35, No. 7, 2011, pp. 1057-1063. doi:10.1007/s00264-010-1093-6

[31]   L. A. Robles, “Transverse Sacral Fractures,” Spine Journal, Vol. 9, No. 1, 2009, pp. 60-69. doi:10.1016/j.spinee. 2007.08.006

 
 
Top