Summary
Indications
Sacrum fractures accompanied by unstable type C pelvic ring fractures with and without neurologic deficits.
Contraindication
Type A and B pelvic ring fractures Severe osteoporosis.
Surgical Technique
Stabilization of unstable pelvic ring injuries.
Direct exposure of fracture and neural elements through a posterior approach.
Internal fixation with plates from AO small fragment set, applying tension band principle.
Stabilization of the anterior part of the pelvic ring (symphysis pubis) through an anterior approach completes the operation (see Figures).
Postoperative Management
After 3rd or 4th postoperative day partial weight bearing on injured side.
Unilateral, well reduced fractures: full weight bearing after 6 weeks.
Comminuted, bilateral fractures: full weight bearing after 12 weeks.
Regular assessment of neurologic status.
Physiotherapy.
Possible Complications
Haemorrhage from presacral plexus.
Iatrogenic injuries of the neural elements.
Thromboembolism, delayed healing, avulsion of implants.
Results
Since 1989 thirteen patients were treated with the here described technique, their mean age: 31.1 years (22 to 62).
Six had neurologic deficits, see Table 1 for details.
In 11 instances transforaminal and twice central sacral fractures were stabilized.
Anatomical reduction achieved in 9 patients, persistent vertical displacement of 5 mm seen in 2 patients, displacement of 10 mm in 1 patient. Secondary displacement of 3 mm in 1 patient.
Follow up of 10 out of 12 surviving patients: average 28 months (12 to 52): 3 excellent results, 3 good results, 4 satisfactory results (according to rating scale in Table 2). Bony consolidation occurred in all sacral fractures.
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Literatur
Bell, A., R. Smith, T. Brown, J. Nepola: Comparative study of the Orthofix and Pittsburgh frames for external fixation of unstable pelvic ring fractures. J. Orthop. Traumatol. 2 (1988), 130–138.
Bonin, J.: Sacral fractures and injuries to the cauda equina. J. Bone Jt Surg. 27 (1945), 113–127.
Denis, F., D. Steven, T. Comfort: Sacral fractures: an important problem, retrospective analysis of 236 cases. Clin. Orthop. 227 (1988), 67–81.
Ecke, H., W. Völkel: Operative Maßnahmen und Ergebnisse bei Verletzungen des knöchernen Beckenringes mit Ausnahme der Acetabulumfraktur. Hefte Unfallheilk. 164 (1984), 234–239.
Egbers, H., F. Draijer, D. Havemann, W. Zenker: Stabilisierung des Beckenrings mit Fixateur externe. Orthopäde 21 (1992), 363–372.
Egbers, H., L. Schroeder, D. Havemann, H. Bömer: Indikationen für die äußere Stabilisation von Beckenringfrakturen. Hefte Unfallheilk. 164 (1984), 292–293.
Gibbons, K., D. Soloniuk, N. Razack: Neurological injury and patterns of sacral fractures. J. Neurosurg. 172 (1990), 889–893.
Havemann, D., L. Schroeder: Behandlung von Bekkenringfrakturen mit Fixateur externe. Akt. Traumatol. 12 (1982), 83–85.
Isler, B., R. Ganz: Klassifikation der Beckenringverletzung. Unfallchirurg 93 (1990), 289–302.
Kellam, J. F., R. Y. McMurtry, D. Paley, M. Tile: The unstable pelvic fracture. Operative treatment. Orthop. Clin. N. Amer. 1 (1987), 25–41.
Mears, D., C. Capito, H. Deleeuw: Posterior pelvic disruptions managed by the use of the double cobra plate. AAOS Instr. Course Lect. 37 (1988), 143–150.
Müller, M., M. Allgöwer, R. Schneider, H. Willenegger: Manual of internal fixation, 3rd ed. In: Chapter 9: Pelvis. Springer, Berlin-Heidelberg-New York 1991, p. 485–500.
Noland, L., H. Conwell: Fractures of the pelvis. Surg. Gynec. Obstet. 56 (1933), 522–525.
Pennal, G., M. Tile, J. Waddel, H. Garside: Pelvic disruption: assessment and classification. Clin. Orthop. 151 (1980), 12–21.
Pohlemann, T., A. Gänsslen, B. Kiessling, U. Bosch, N. Haas, H. Tscherne: Indikationsstellung und Osteosynthesetechniken am Beckenring. Unfallchirurg 95 (1992), 197–209.
Pohlemann, T., A. Gänsslen, H. Tscherne: Die Problematik der Sakrumfraktur, klinische Analyse von 377 Fällen. Orthopäde 21 (1992), 400–412.
Pohlemann, T., B. Kiessling, A. Gänsslen, U. Bosch, H. Tscherne: Standardisierte Osteosynthesetechniken am Beckenring. Orthopäde 21 (1992), 373–384.
Rubash, H., T. Brown, D. Nelson, D. Mears: Comparative mechanical performance of some new devices for fixation of unstable pelvic ring fractures. Med. biol. Engng Comput. 21 (1983), 657–663.
Schmidek, H., D. Schmith, D. Kristiansen: Sacral fractures. Neurosurgery 15 (1984), 735–746.
Simpson, L. A., J. P. Waddell, R. K. Leighton, J. F. Kellam, M. Tile: Anterior approach and stabilization of the disrupted sacroiliac joint. J. Trauma 12 (1987), 1332–1339.
Tile, M., G. Pennal: Pelvic disruptions: principles of management. Clin. Orthop. 151 (1980), 56–64.
Vécsei, V.: Ergebnisse biomechanischer Untersuchungen verschiedener F.-e.-Montagen am Becken. Akt. Traumatol. 18 (1988), 261–264.
Wakeley, C.: Fractures of the pelvis: an analysis of 100 cases. Brit. J. Surg. 17 (1930), 22–29.
Wild, J., G. Hanson, H. Tullos: Unstable fractures of the pelvis treated by external fixation. J. Bone Jt Surg. 7 (1982), 1010–1019.
Wörsdörfer, O., F. Magerl: Sacrumfrakturen. Hefte Unfallheilk. 149 (1980), 203–214.
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Pohlemann, T., Tscherne, H. Die operative Therapie von Sakrumfrakturen. Operat Orthop Traumatol 8, 55–72 (1996). https://doi.org/10.1007/BF02510295
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DOI: https://doi.org/10.1007/BF02510295