Abstract
Introduction
Isolated U-shaped sacral fractures are rare entities, mostly seen in polytraumatized patients, and hence, they are difficult to diagnose. While the pelvic ring remains intact across S2/S3, the U-shaped fracture around S1 leads to marked instability between the base of the spine and the pelvis. As severe neurological deficits can occur, timely treatment of these fractures is crucial. We present a novel technique of percutaneous reduction and trans-sacral screw fixation in U-shaped fractures.
Material and Methods
3 multiply injured patients with u-shaped sacral fractures (female, age 21.7±7.23). Two underwent immediate fracture fixation. In the third case delayed reduction and fixation was performed after referral 6 weeks following open decompression.
In prone position, a pair of Schanz pins was inserted into pelvis at the PSIS. A second pair of Schanz pins was inserted into S1 or L5. All pins were inserted percutaneously. The fracture was reduced indirectly, using the Schanz pins as levers. After image intensifier control of the reduction result, two trans-sacral screws were inserted for finite fixation.
Results
In all three cases, this novel method of percutaneous reduction allowed an anatomical sacral alignment and stabilization with trans-sacral screws was initially sufficient.
At 1 year follow-up, both immediately fixed fractures showed an anatomical sacral alignment. Both had no neurological deficits, no signs of screw-loosening and were pain free.
Unfortunately the delayed fixation showed a new tilt and hence loss of sacral alignment. This might be due to posterior structural integrity loss after decompression.
Conclusion
U-shaped sacral fractures are rare, but correct and immediate treatment is paramount to achieve good outcome. Percutaneous reduction and screw fixation offers a less invasive treatment method. Anatomical alignment and stabilisation is possible and time of surgery can be reduced significantly.
