Lumbopelvic Fixation and Sacral Decompression for U-shaped Sacral Fractures： Surgical Management and Early Outcome

U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently cause neurological deficits. The majority of surgeons have limited experience in management of U-shaped sacral fractures. No standard treatment protocol for U-shaped sacral fractures has been available till now. This study aimed to examine the management of U-shaped sacral fractures and the early outcomes. Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed. Demographics, fracture classification, mechanism of injury and operative treatment and deformity angle were assessed. All the patients were treated with lumbopelvic fixation or （and） sacral decompression. EQ-5d score was applied to evaluate the patients＇ quality of life. Of the 15 consecutive patients with U-shaped sacral fracture, the mean age was 28.8 years （range： 15-55 years） at the time of injury. There were 6 females and 9 males. The mean follow- up time was 22.7 months （range： 9-47 months） and mean full weight-bearing time was 9.9 weeks （range： 8-14 weeks）. Ten patients received lumbopelvic fixation and sacral decompression, one lombosacral fixation, and 4 merely sacral decompression due to delayed diagnosis or surgery. The post-operation deformity angle （mean 27.87°, and range： 8°-90°） of the sacrum was smaller than that pre-operation （mean 35.67; range： 15-90） with no significance difference noted. At the latest follow-up, all patients obtained neurological recovery with different extents. Visual analogue score （VAS） was reduced from preoperative 7.07 （range： 5-9） to postoperetive 1.93 （range： 1-3）. All patients could walk without any aid after treatment. Eight patients were able to care for themselves and undertook some daily activities. Five patients had returned to work full time. In conclusion, lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed. Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery. Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.

Computer navigation-assisted minimally invasive percutaneous screw placement for pelvic fractures

Pelvic fractures are often caused by high-energy injuries and accompanied by hemodynamic instability.Traditional open surgery has a large amount of bleeding,which is not suitable for patients with acute pelvic fracture.Navigationguided,percutaneous puncture-screw implantation has gradually become a preferred procedure due to its advantages,which include less trauma,faster recovery times,and less bleeding.However,due to the complexity of pelvic anatomy,doctors often encounter some problems when using navigation to treat pelvic fractures.This article reviews the indications,contraindications,surgical procedures,and related complications of this procedure for the treatment of sacral fractures,sacroiliac joint injuries,pelvic ring injuries,and acetabular fractures.We also analyze the causes of inaccurate screw placement.Percutaneous screw placement under navigational guidance has the advantages of high accuracy,low incidence of complications and small soft-tissue damage,minimal blood loss,short hospital stays,and quick recovery.There is no difference in the incidence of complications between surgeries performed by new doctors and experienced ones.However,computer navigation technology requires extensive training,and attention should be given to avoid complications such as screw misplacement,intestinal injury,and serious blood vessel and nerve injuries caused by navigational drift.

Application of navigation template to fixation of sacral fracture using three-dimensional reconstruction and reverse engineering technique

Objective： To provide a new method in the fixation of sacral fracture by means of three-dimensional reconstruction and reverse engineering technique. Methods： Pelvis image data were obtained from threedimensional CT scan in patients with sacral fracture. The data were transferred into a computer workstation. The threedimensional models of pelvis were reconstructed using Amira 3.1 software and saved in STL format. Then the threedimensional fracture models were imported into Imageware 9.0 software. Different situations of reduction （total reduction, half reduction and non-reduction） were simulated using Imageware 9.0 software. The best direction and location of extract iliosacral lag screws were defined using reverse engineering according to these three situations and navigation templates were designed according to the anatomic features of the postero-iliac part and the channel. The exact navigational template was made by rapid prototyping. Drill guides were sterilized and used intraoperatively to assist in surgical navigation and the placement of iliosacral lag screws. Results： Accurate screw placement was confirmed with postoperative X-ray and CT scanning. The navigation template was found to be highly accurate. Conclusion： The navigation template may be a useful method in minimal-invasive fixation of sacroiliac joint fracture.