Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing.
OBJECTIVE
Presentation of a new triangular osteosynthesis technique that permits early weight-bearing in vertically unstable sacral fractures.


METHODS
Retrospective evaluation of a consecutive series.


METHODS
Level I trauma center.


METHODS
Thirty-four patients, twenty-eight of whom were polytraumatized, all with vertically unstable sacral fractures. This group included eight women and twenty-six men, with a mean age of thirty-five years. Average time between trauma and definite operation was thirteen days (range 0 to 28 days).


METHODS
All patients underwent triangular osteosynthesis using a combination of a vertical vertebropelvic distraction osteosynthesis (pedicle screw system) and a transverse fixation of the sacrum fracture with either iliosacral screws or transsacral plating. Immediate postoperative weight-bearing was permitted postoperatively.


RESULTS
Nineteen patients were treated with early progressive weight-bearing and advanced to full weight-bearing, on average, after twenty-three days (range 8 to 70 days). Three of the thirty-four patients (9 percent) experienced loosening of hardware, including two patients (6 percent) who required secondary intervention because of loss of the original reduction. Further complications included one pulmonary embolism (3 percent), one iatrogenic nerve lesion (3 percent), one wound necrosis (3 percent), and two local infections (6 percent).


CONCLUSIONS
Triangular osteosynthesis is a demanding procedure that can be performed on vertically unstable sacral fractures to allow early progressive weight-bearing with an acceptable complication rate.
BG-Kliniken Bergmannsheil Bochum, Chirurgische Klinik und Poliklinik, Universitätsklinik, Germany.
T A
TA
Schildhauer
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C
Josten
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Muhr
D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D004868:Equipment Failure; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery; D010388:Pelvis / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D016474:Weight-Bearing