Stabilisation of Unstable Sacrum Fractures

Abstract

As the most caudal part of the spine, the sacrum is the biomechanical link between the trunk and pelvis. Unstable sacral injuries, therefore, also form part of unstable pelvic ring fractures. Patients who suffer these types of injuries usually have multiple traumas and have lost a lot of blood. That is why stabilisation measures must at the same time be both gentle and effective. They provide the foundation for the important intensive care positioning techniques, later mobilisation and, ultimately, the healing of the fractures. Stabilisation should be simple, minimally invasive and associated with the least possible risks regarding iatrogenic injury. Internal transfixation of the sacrum and the adjacent joints by means of lumbo-iliac instrumentation is particularly suited to doing so. This strategy, which has now been practised for 14 years, fulfils all of the criteria outlined above. The technique has been perfected to such an extent, by means of applying instrumentation on both sides, that precise reduction and retention can be achieved and re-dislocation under load application is effectively prevented by the posterior-cranial to anterior-caudal direction of the iliac screw. The use of a newly developed 6/6 mm rod connector in particular means that the described method is an important addition to the alternative procedures available for posterior pelvic ring treatment.

Key words

Unstable sacrum fractures - posterior transfixation - distraction - spondylodesis

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