title: Minimal-invasive percutaneous reduction and transsacral screw fixation for U-shaped fractures.
abstract: METHODS
  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.
  
  
  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.
authors.affiliation: The Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham, UH, UK.
authors.forename: Matthias Alexander
authors.initials: MA
authors.lastname: König
authors.forename: Ulrich
authors.initials: U
authors.lastname: Seidel
authors.forename: Paul
authors.initials: P
authors.lastname: Heini
authors.forename: Rene
authors.initials: R
authors.lastname: Orler
authors.forename: Nasir Ali
authors.initials: NA
authors.lastname: Quraishi
authors.forename: Alexandra Anastasia
authors.initials: AA
authors.lastname: Boszczyk
authors.forename: Bronek Maximilian
authors.initials: BM
authors.lastname: Boszczyk
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D012447:Sacrum / Q000293:injuries* / Q000601:surgery*; D016103:Spinal Fractures / Q000601:surgery*; D016896:Treatment Outcome