Modified triangular posterior osteosynthesis of unstable sacrum fracture.

We report preliminary results for unstable sacral fractures treated with a modified posterior triangular osteosynthesis. Seven patients were admitted to our trauma center with an unstable sacral fracture. The average age was 31 years (22-41). There were four vertical shear lesions of the pelvis and three transverse fracture of the upper sacrum. The vertical shear injuries were initially treated with an anterior external fixator inserted at the time of admission. Definitive surgery was performed at a mean time of 9 days after trauma. The operation consisted in a posterior fixation combining a vertebropelvic distraction osteosynthesis with pedicle screws and a rod system, whereby the transverse fixation was obtained using a 6 mm rod as a cross-link between the two main rods. Late displacement of the posterior pelvis or fracture was measured on X-ray films according to the criteria of Henderson. The patients were followed-up for a minimum time of 12 months. Four patients who presented with a pre-operative perineal neurological impairment made a complete recovery. No iatrogenic nerve injury was reported. One case of deep infection was managed successfully with surgical debridement and local antibiotics. All patients complained of symptoms related to the prominence of the iliac screws. The metalwork was removed in all cases after healing of the fracture, at a mean time of 4.3 months after surgery. No loss of reduction of fracture was seen at final radiological follow-up. The preliminary results are promising. The fixation is sufficiently stable to allow an immediate progressive weight-bearing, and safe nursing care in polytrauma cases. The only problem seems to be related to prominent heads of the distal screws

Treatment of posterior pelvic ring injuries with minimally invasive percutaneous plate osteosynthesis

From January 2004 to July 2007, 21 patients with injuries at the posterior pelvic ring were treated with locking compression plate osteosynthesis through a minimally invasive approach and followed up for a mean of 12.2 months. Preoperative and postoperative radiography was conducted to assess the reduction and union. The mean operation time was 60 minutes (range: 40–80). Intraoperative blood loss was 50–150 ml. All patients achieved union at the final follow-up. The overall radiological results were excellent or good in 17 patients (85%). The functional outcome was excellent or good in 18 patients (90%). There was no iatrogenic nerve injury, deep infection or failure of fixation. We believe that fixation with a locking compression plate is an effective method for the treatment of injuries of the posterior pelvic ring in view of its convenience, minimal traumatic invasion and lower morbidity