Abstract
Purpose
Spinopelvic fixation and triangular osteosynthesis give firm internal fixation for unstable pelvic ring injuries (UPRI), but with sacrifice of mobility of the lumbar spine. Here, we describe the procedure and outcomes of a new approach, which we refer to as “within ring”-based sacroiliac rod fixation (SIRF).
Methods
The patient was placed in a prone position and longitudinal skin incisions were made at the medial margins of the bilateral posterior superior iliac spines (PSIS). After reduction of fracture, a pedicle screw was inserted into the first sacral vertebra on the injured side and iliac screws inserted through the bilateral PSIS were bridged using rods.
Results
SIRF was performed in 15 patients. The AO/OTA classification was 61-B2.3 in 1, C1.3 in 4, C2.3 in 7, C3.3 in 1, and H-type spinopelvic dissociation in two cases. The mean operative time was 179 (110–298) minutes, mean blood loss was 533 (100–2700) cc. One patient died during hospitalization and three patients stopped outpatient treatment. The other 11 patients achieved bone union without major loss of reduction in a mean post-operative follow-up period of 23.8 (4–50) months. The mean Majeed score at final follow-up was 86.7 (73–96) out of 96, excluding scoring sexual intercourse.
Conclusions
“Within ring”-based SIRF not including the lumbar spine in the fixation range is a simple, safe, and low-invasive internal fixation method for UPRI.
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References
Kach K, Trentz O (1994) Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis [in German]. Unfallchirurg 97:28–38
Bellabarba C, Schildhauer TA, Vaccaro AR et al (2006) Complications associated with surgical stabilization of high-grade sacral fracture displacements with spino-pelvic instability. Spine 31:S80–S88
Schildhauer TA, Bellabarba C, Nork SE et al (2006) Decompression and lumbopelvic fixation for sacral fracture-displacements with spino-pelvic dissociation. J Orthop Trauma 20:447–457
Sagi HC, Militano U, Caron T et al (2009) A comprehensive analysis with minimum 1-year follow-up of vertically unstable transforaminal sacral fractures treated with triangular osteosynthesis. J Orthop Trauma 23:313–319
Bederman SS, Hassan JM, Shah KN, Kiester PD et al (2013) Fixation techniques for complex traumatic transverse sacral fractures: a systematic review. Spine 38:E1028–E1040
Lindahl J, Mäkinen TJ, Koskinen SK et al (2014) Factors associated with outcome of spinopelvic dissociation treated with lumbopelvic fixation. Injury 45:1914–1920
Konig MA, Jehan S, Boszczyk AA et al (2012) Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies. Eur Spine J 21:829–836
Pearcy MJ, Portek I, Shepherd J (1984) Three dimensional X-ray analysis of normal movement in the lumbar spine. Spine 9:294–297
Keel MJB, Benneker LM, Siebenrock KA (2011) Less invasive lumbopelvic stabilization of posterior pelvic ring instability. J Trauma 71:E62–E70
Mouhsine E, Wettstein M, Schizas C et al (2006) Modified triangular posterior osteosynthesis of unstable sacrum fracture. Eur Spine J 15:857–863
Toogood P, McDonald E, Pekmezci M (2013) A biomechanical comparison of ipsilateral and contralateral pedicle screw placement for modified triangular osteosynthesis in unstable pelvic fractures. J Orthop Trauma 27:515–520
Karakaşlı A, Ceçen B, Erduran M, Taylan O, Hapa O, Havıtcıoğlu H (2014) Rigid fixation of the lumbar spine alters the motion and mechanical stability at the adjacent segment level. Eklem Hastalik Cerrahisi 25:42–46
Lawrence BD, Wang J, Arnold PM, Hermsmeyer J, Norvell DC, Brodke DS (2012) Predicting the risk of adjacent segment pathology after lumbar fusion: asystematic review. Spine 37:S123–S132
Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE (2004) Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine 29:1938–1944
Keel MJ, Benneker LM, Siebenrock KA, Bastian JD (2011) Less invasive lumbopelvic stabilization of posterior pelvic ring instability: technique and preliminary results. J Trauma 71:62–70
König MA, Seidel U, Heini P, Orler R, Quraishi NA, Boszczyk AA, Boszczyk BM (2013) Minimal-invasive percutaneous reduction and transsacral screw fixation for U-shaped fractures. J Spinal Disord Tech 26:48–54
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Futamura, K., Baba, T., Mogami, A. et al. “Within ring”-based sacroiliac rod fixation may overcome the weakness of spinopelvic fixation for unstable pelvic ring injuries: technical notes and clinical outcomes. International Orthopaedics (SICOT) 42, 1405–1411 (2018). https://doi.org/10.1007/s00264-017-3712-y
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DOI: https://doi.org/10.1007/s00264-017-3712-y