Modified triangular posterior osteosynthesis of unstable sacrum fracture

Mouhsine, Elyazid; Wettstein, Michaël; Schizas, Constantin; Borens, Olivier; Blanc, C.-H.; Leyvraz, P. F.; Theumann, Nicolas; Garofalo, Raffaele

doi:10.1007/s00586-004-0858-2

Cited by 76 publications

(62 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Biomechanical analysis confirmed that triangular segmental lumbopelvic instrumentation is the most stable fixation method [12,19]. Such strong fixation allows patients to do early mobilization and carry out progressive weight-bearing activity post-operation [12,14]. In this series, all patients were treated with iliosacral screw combined with USS fixation, and were permitted to do early physical rehabilitation exercise, to get out of bed with crutches or a walker 3-7 days post-operation, and can have full weight-bearing ability 4-6 weeks post-operation.…”

Section: Discussionmentioning

confidence: 87%

“…However, Schildhauer et al [12] pointed out that this kind fixation cannot guarantee rotational stability because it addresses vertical forces only, whereas rotational stability cannot be achieved by the vertical twopoint fixation. To solve this problem, triangular osteosynthesis for unstable sacral fractures had been recently introduced [12][13][14][15][16]. This fixation combines a transverse fixation with a lumbopelvic distraction osteosynthesis, providing clinically and biomechanically sufficient multiplanar stability [16,18].…”

Section: Discussionmentioning

confidence: 99%

“…Sometimes, however, the L4 pedicle should be chosen:, (1) when the L5 pedicle is fractured or the avulsion extends to L5 transverse process, which makes the insertion of the L5 pedicle screw difficult or the screw is unstable; and (2) during lumbosacral lordosis or in sacralization of L5, a vertebropelvec fixation between L5 and iliac turns to be a horizontal fixation which cannot resist vertical shear. Mouhsine et al [14] selected two pedicle screws, L4 and L5, which can provide sufficient stability; however, the lumbar mobilities of L4 and L5 were sacrificed. Sar [21] introduced S1 pediculoiliac screw fixation to a patient with sacral alar fracture (zone 1) and another one with sacroiliac joint instability.…”

Section: Discussionmentioning

confidence: 99%

“…Sagi et al [15] used only one iliosacral screw for horizontal fixation, but the anterior pelvic ring was stabilized in cases of wide rami displacement or symphyseal diastasis. Mouhsine et al [14] modified triangular osteosynthesis for unstable sacral fractures. In their study, the horizontal fixation was performed with a 6-mm rod used as a crosslink between the two connecting rods.…”

Section: Discussionmentioning

confidence: 99%

“…However, none of these fixation instruments can resist vertical shear forces, provide unrestricted weightbearing, and secure mobilization after operation. Recent studies demonstrated that triangular osteosynthesis is a new option for the treatment of type C pelvic fracture following unstable sacral fractures [12][13][14][15][16]. This fixation combines a lumbopelvic distraction osteosynthesis and a transverse fixation, which provides multiplanar stability.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Application triangular osteosynthesis for vertical unstable sacral fractures

Pei

Wang

et al. 2012

Eur Spine J

View full text Add to dashboard Cite

Purpose The aim of this study was to explore the operative technique and effectiveness of triangular osteosynthesis for vertically unstable sacral fractures. Methods From January 2009 to December 2010, 25 vertical unstable sacral fractures in 22 patients were treated with triangular osteosynthesis using the combination of universal spine system and iliosacral screw in our institution. Patients were followed up prospectively with routine post-operation visits for clinical and radiographic examination. The reduction quality was evaluated according to Matta criterion. Clinical function outcome, and nerve function outcome was evaluated by Majeed and Gibbons criterion. Results All patients were followed up for an average of 14 months (range 8-26 months). Local infection was seen in two patients, and both were healed with debridement and antibiotics. Patients experienced early weight-bearing ability, no fracture reduction loss, and hardware loosening, while all fractures appeared as bone union at the final follow-up. According to Matta criterion for fracture reduction, the results were excellent in 18 sides, good in 6 sides, and fair in 1 side. According to Majeed functional scoring at last follow-up, the results were excellent in 13 cases, good in 6 cases, fair in 2 cases, and poor in 1 case. Neurologic impairment was noted in 13 patients preoperative, six patients achieved complete recovery, six patients achieved partial improvement, one patient did not have any improvement at the last follow-up.Conclusion Triangular osteosynthesis is a relatively new fixation for vertical unstable sacral fractures, the fixation is rigid, permits early full weight-bearing, and nerve decompression can be performed, which facilitates function recovery.

show abstract