Triangular Osteosynthesis of Vertically Unstable Sacrum Fractures: A New Concept Allowing Early Weight-Bearing

Schildhauer, Thomas A.; Josten, Ch.; Muhr, G.

doi:10.1097/00005131-199806000-00002

Cited by 206 publications

(174 citation statements)

References 14 publications

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“…Different internal fixation implants have been proposed to reconstruct the posterior pelvic ring, but all of these [18] applied lumbopelvic distraction spondylodesis for the treatment of sacral fractures; this procedure oriented in the vertical direction between the pedicle of L4 or L5 and the crista iliaca, which is a logical protection against cranial migration of the injured half of the pelvic ring. 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].…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…This fixation combines a transverse fixation with a lumbopelvic distraction osteosynthesis, providing clinically and biomechanically sufficient multiplanar stability [16,18]. 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].…”

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%

“…This fixation combines a lumbopelvic distraction osteosynthesis and a transverse fixation, which provides multiplanar stability. This technique of sacral fracture stabilization facilitates early mobilization, reduces mortality, protects the local neuroanatomy from additional injury which may be caused by progressive deformity, and improves long-term outcomes [12]. The purpose of this article is to show the preliminary results of vertical unstable sacral fractures treated with triangular osteosynthesis.…”

Section: Introductionmentioning

confidence: 99%

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Application triangular osteosynthesis for vertical unstable sacral fractures

Pei

Wang

et al. 2012

Eur Spine J

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Application triangular osteosynthesis for vertical unstable sacral fractures

Pei

Wang

et al. 2012

Eur Spine J

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Biomechanical investigation of S2 alar‐iliac screw and S1 pedicle screw fixation in the treatment of Denis type II sacral fractures

Zheng

Liu

Xiang

et al. 2022

Journal Orthopaedic Research

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Although S2 alar-iliac screw technique has been widely used in spinal surgery, its applicability to pelvic fractures is largely unknown. This study aimed to evaluate the biomechanical stability of S2 alar-iliac screw and S1 pedicle screw fixation in the treatment of Denis II sacral fractures. Twenty-eight artificial pelvic fracture models were treated with unilateral lumbopelvic fixation, sacroiliac screw fixation, S2 alar-iliac screw and S1 pedicle screw fixation, and S2 alar-iliac screw and contralateral S1 pedicle screw fixation (Groups 1-4, respectively; N = 7 per group). Each model was cyclically tested under increasing axial compression. Optical motion-tracking was used to assess relative displacement and gap angle, and the number of failure cycles. Relative displacement was significantly smaller in Group 3 than in Groups 1 (p = 0.004) and 4 (p < 0.001) but not significantly different between Groups 3 and 2 (p = 0.290). The gap angle in Group 3 was significantly smaller than that in Group 1 (p = 0.009) on the sagittal plane but significantly larger than that in Group 4 (p = 0.006) on the horizontal plane. A number of failure cycles was significantly higher in Group 3 than in Groups 1 (p = 0.002) and 4 (p = 0.004) but not significantly different between Groups 3 and 2 (p = 0.910). From a biomechanical perspective, S2 alar-iliac screw and S1 pedicle screw fixation can provide good stability in the treatment of Denis II sacral fractures.

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