title: Fixation techniques for complex traumatic transverse sacral fractures: a systematic review.
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  To identify and describe reconstruction methods for the treatment of transverse sacral fracture (TSF) and to evaluate outcomes based on treatment interventions.
  
  
  BACKGROUND
  A variety of surgical interventions for stabilization of TSFs exist, yet the optimal management remains unclear. Although there are many individual case reports and series describing techniques to stabilize TSF, prior reviews fail to provide a comprehensive summary of current and past surgical techniques and their individual outcomes.
  
  
  METHODS
  Our systematic review searched the PubMed database using keywords identifying sacral fractures with a transverse component, requiring internal fixation for stabilization as well as a review of bibliographies and archives from meeting proceedings.
  
  
  RESULTS
  Our search located 417 publications for abstract review, of which 27 (109 patients) with TSF were included. Average follow-up was 22 months (range, 0-82 mo). Thirty-eight patients (34%) underwent spinopelvic fixation (SPF), 53 (49%) underwent posterior pelvic ring fixation (PPRF), and 18 (17%) underwent both. PPRF included iliosacral screws (37 patients), transiliac screws (11 patients), transiliac screws with plating (3 patients), posterior plating (1 patient), and transiliac bar (1 patient). Additional injuries causing lumbosacral instability were seen in 8 patients (42%) who underwent SPF, 2 patients (18%) treated with PPRF, and 5 patients (45%) who were treated with both SPF and PPRF. Of those who presented with a neurological deficit, 5 patients (45%) with SPF, 9 (39%) with PPRF, and 3 (30%) with SPF and PPRF experienced full neurological recovery. Five patients (45%) with SPF, 7 (30%) with PPRF, and 5 (50%) with both regained partial neurological function. One patient (9%) with SPF, 7 (30%) with PPRF, and 2 (20%) with both experienced no neurological recovery.
  
  
  CONCLUSIONS
  PPRF seems to be effective for stabilization of TSF. However, in the setting of further injuries causing additional lumbosacral instability, SPF should be used to ensure effective stabilization.
authors: Department of Orthopaedic Surgery, University of California at Irvine, Orange, CA 92868, USA. sbederma@uci.edu
authors: S Samuel
authors: SS
authors: Bederman
authors: Jeffrey M
authors: JM
authors: Hassan
authors: Kalpit N
authors: KN
authors: Shah
authors: P Douglas
authors: PD
authors: Kiester
authors: Nitin N
authors: NN
authors: Bhatia
authors: David P
authors: DP
authors: Zamorano
mesh_terms: D001860:Bone Plates; D001863:Bone Screws; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D009984:Orthopedic Fixation Devices; D012447:Sacrum / Q000293:injuries / Q000601:surgery*; D016103:Spinal Fractures / Q000209:etiology / Q000601:surgery*; D013124:Spinal Injuries / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome