Stabilization of fatigue fractures of the dorsal pelvis with a trans-sacral bar. Operative technique and outcome.

INTRODUCTION

Due to ageing of our population the number of fatigue fractures of the pelvic ring is steadily growing. These fractures are often treated with bed rest but may result in a disabling immobility with severe pain. An operative treatment is an option in these cases. The aim of operative treatment is bony healing obtained by stable fixation giving back to the patient's previous mobility. Optimal surgical treatment is currently under debate. Sacroiliac screw fixation and sacroplasty are used for stabilization of the dorsal pelvis. Due to the technique and the low density of spongious sacral bone, no or only low compression in the fracture site is obtained, which may inhibit bony healing. The trans-sacral bar compression osteosynthesis is presented as an alternative procedure. We present the outcome of 11 patients, who were treated with this method.

METHODS

The patient is placed in prone position on the operation table. Under image intensifier control, a 5mm threaded sacral bar is inserted through the body of S1 from the left to the right dorsal ilium. Nuts are placed over the bar achieving fracture compression. When anterior pelvic instability is present, an anterior osteosynthesis is also performed. Clinical and radiological outcome were evaluated one year after index surgery with different scoring systems.

RESULTS

Eleven patients (9 F and 2 M) were treated between 2005 and 2010. The mean age of the patients was 73 years at time of operation. There were no mechanical complications. Postoperatively there was a temporary nerve palsy of L5 in one case. The mean follow-up was 14 months. In all patients, a bony healing of the dorsal pelvic ring was achieved. Seven patients showed a major clinical improvement, in four patients a moderate.

CONCLUSIONS

Trans-sacral bar osteosynthesis is a promising method for stabilization of fatigue fractures of the pelvic ring. Only with this method, a high interfragmentary compression is achieved, independent of the quality of the spongious bone of the sacral body.