[Open reduction and internal fixation of unstable sacral fractures].
Sacral fractures are frequently misdiagnosed or overlooked, as the majority of the patients are suffering from polytrauma situations. Obvious clinical signs both of the fracture and the associated neurological complications are missing. A poor longterm outcome with pain and urogenital disorders is frequent. Based on clinical and biomechanical studies a new concept for internal fixation of transsacral pelvic instabilities combined with decompression of the central canal is applied. To approach the sacrum, a posterior longitudinal incision is carried out and can be modified according to the fracture pattern. Decompression and anatomic reduction is performed and the fracture stabilized with minimized small fragment implants which are solely fixed in the sacrum. 32 patients were treated according to this protocol between 1989 and 1996. Bony healing occurred in all but one case. A complete anatomical sacral reconstruction was achieved in 80 % of the cases, another 16 % had close to anatomic (< 5 mm) reconstruction. In eight cases a primary neurologic deficit was present, with five complete or partial recoveries directly postoperative. Complications occurred in seven patients with two secondary displacements.
Gänsslen
A
A
Chirurgische Klinik und Poliklinik, Abteilung Unfall-, Hand- und Wiederherstellungschirurgie, Universitätskliniken des Saarlandes. axel.gaensslen@uniklinik-saarland.de
Pape
H C
HC
Lehmann
U
U
Lange
U
U
Krettek
C
C
Pohlemann
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000000981:diagnostic imaging / Q000601:surgery; D009460:Neurologic Examination; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D012086:Reoperation; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D014057:Tomography, X-Ray Computed