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Double locking plate fixation of sacral fractures in unstable pelvic ring C-type injuries

Doppelplattenfixation von Sakrumfrakturen bei instabilen Beckenringfrakturen vom Typ C

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An Erratum to this article was published on 08 February 2015

Abstract

Objective

Alternative sacrum fixation with double-plate osteosynthesis in vertical unstable pelvic fractures. The surgical technique allows anatomic reduction and osteosynthesis of the sacrum component.

Indications

All vertical unstable pelvic ring fractures 61-C type according to AO/OTA system with associated displaced sacrum fractures

Contraindications

Hemodynamic unstable patients, fractures with major sacroiliac joint involvement, nondisplaced sacrum fractures.

Surgical technique

In prone position, a midline incision exposing the sacrum fracture is needed. The fracture is distracted and interjacent bone fragments or hematoma can be evacuated. The fracture is anatomically reduced and compressed. Two anatomically bent 3.5-mm locked compression plates (LCP) are placed on the dorsal aspect of the sacrum. In Denis type II and III fractures, the lateral screws can be placed in the lateral aspect of the sacrum. In Denis type I fractures, the lateral screws are placed in the ilium lateral to the sacroiliac joint to improve purchase. Additional short monocortical locking screws in the middle part of the plates increase the vertical stability to the osteosynthesis. Fracture fixation of the anterior ring follows the dorsal procedure.

Postoperative management

The patient is mobilized with partial weight bearing. Clinical and radiological follow-up is planned after 6 and 12 weeks.

Results

A total of 27 patients with vertical unstable pelvic fractures were identified and treated with open reduction and double-plate osteosynthesis. The Iowa pelvic score was rated excellent in 83 % and good in 17 % of cases. One patient developed a nonunion and had to be revised.

Zusammenfassung

Operationsziel

Alternative Fixation einer Sakrumfraktur bei vertikal instabilen Beckenfrakturen mit einer Doppelplattentechnik. Die Operation erlaubt die anatomische Reposition der Sakrumfraktur.

Indikationen

Alle vertikal instabilen Beckenringfrakturen vom Typ 61-C gemäß dem AO/OTA-System mit dislozierter Sakrumfraktur.

Kontraindikationen

Hämodynamisch instabile Patienten. Frakturen, die hauptsächlich transiliosakral verlaufen und undislozierte Sakrumfrakturen.

Operationstechnik

Der Patient wird zuerst in Bauchlage gelagert. Es folgt eine Mittellinieninzision zur submuskulären Darstellung des Sakrums. Anschließend wird die Frakturzone distrahiert und interponierende Knochenfragmente oder Hämatome werden entfernt. Die Fraktur wird reponiert und komprimiert. Zwei vorgebogene 3,5-mm-LCP („locked compression plates“) werden in direktem Knochenkontakt auf das Sakrum appliziert, um die Fraktur zu überbrücken. Bei Denis-Typ-I-Frakturen werden die lateralen Schrauben lateral des Iliosakralgelenks (ISG) ins Ilium gesetzt, um ausreichenden Halt zu gewährleisten. Bei Denis-Typ-II- und -III-Frakturen können die lateralen Schrauben unmittelbar medial des ISG in das laterale Sakrum eingebracht werden. Zusätzliche kurze monokortikale Schrauben in den medialen Plattenlöchern erhöhen die vertikale Stabilität und verhindern Scherbewegungen. Die Stabilisierung des ventralen Beckenrings erfolgt üblicherweise im Anschluss.

Weiterbehandlung

Der Patient wird mit Teilbelastung der betroffenen Seite mobilisiert. Klinische und radiologische Kontrollen sind nach 6 und 12 Wochen geplant.

Ergebnisse

Retrospektiv wurden 27 Patienten mit vertikal instabiler Beckenringfraktur und offen reponierter Sakrumfraktur identifiziert. Der Iowa-Beckenscore wurde in 83 % als sehr gut und in 17 % als gut gewertet. Ein Patient zeigte eine verzögerte Frakturheilung (non-union) und musste revidiert werden.

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Compliance with ethical guidelines

Conflict of interest. Y. P Acklin, G. Marco and C. Sommer state that there are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. General Surgery, Trauma unit, Kantonsspital Graubünden, Loestr. 170, 7000, Chur, Switzerland

    Y.P. Acklin MD, DMedSc, G. Marco MD & C. Sommer MD

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  1. Y.P. Acklin MD, DMedSc
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  2. G. Marco MD
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  3. C. Sommer MD
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Correspondence to Y.P. Acklin MD, DMedSc.

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Acklin, Y., Marco, G. & Sommer, C. Double locking plate fixation of sacral fractures in unstable pelvic ring C-type injuries. Oper Orthop Traumatol 27, 74–79 (2015). https://doi.org/10.1007/s00064-014-0307-2

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  • DOI: https://doi.org/10.1007/s00064-014-0307-2

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