Minimal-invasive percutaneous reduction and transsacral screw fixation for U-shaped fractures

König, Matthias Alexander; Seidel, Ulrich; Heini, Paul; Orler, Rene; Quraishi, Nasir Ali; Boszczyk, Alexandra Anastasia; Boszczyk, Bronek Maximilian (2013). Minimal-invasive percutaneous reduction and transsacral screw fixation for U-shaped fractures. Journal of spinal disorders & techniques, 26(1), pp. 48-54. Lippincott Williams & Wilkins 10.1097/BSD.0b013e3182318539

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STUDY DESIGN

Technical note and case series.

OBJECTIVE

To introduce an innovative minimal-invasive surgical procedure reducing surgery time and blood loss in management of U-shaped sacrum fractures.

SUMMARY OF BACKGROUND

Despite their seldom appearance, U-shaped fractures can cause severe neurological deficits and surgical management difficulties. According to the nature of the injury normally occurring in multi-injured patients after a fall from height, a jump, or road traffic accident, U-shaped fractures create a spinopelvic dissociation and hence are highly unstable. In the past, time-consuming open procedures like large posterior constructs or shortening osteotomies with or without decompression were the method of choice, sacrificing spinal mobility. Insufficient restoration of sacrococcygeal angle and pelvic incidence with conventional techniques may have adverse long-term effects in these patients.

METHODS

In a consecutive series of 3 patients, percutaneous reduction of the fracture with Schanz pins inserted in either the pedicles of L5 or the S1 body and the posterior superior iliac crest was achieved. The Schanz pins act as lever, allowing a good manipulation of the fracture. The reduction is secured by a temporary external fixator to permit optimal restoration of pelvic incidence and sacral kyphosis. Insertion of 2 transsacral screws allow fixation of the restored spinopelvic alignment.

RESULTS

Anatomic alignment of the sacrum was possible in each case. Surgery time ranged from 90 to 155 minutes and the blood loss was <50 mL in all 3 cases. Two patients had very good results in the long term regarding maintenance of pelvic incidence and sacrococcygeal angle. One patient with previous cauda equina decompression had loss of correction after 6 months.

CONCLUSIONS

Percutaneous reduction and transsacral screw fixation offers a less invasive method for treating U-shaped fractures. This can be advantageous in treatment of patients with multiple injuries.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery

UniBE Contributor:

Seidel, Ulrich

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1536-0652

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Stephanie Schmutz

Date Deposited:

04 Apr 2014 11:02

Last Modified:

04 Apr 2014 11:02

Publisher DOI:

10.1097/BSD.0b013e3182318539

PubMed ID:

21959838

URI:

https://boris.unibe.ch/id/eprint/42413

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