Minimal Access Fixation of Longitudinal Sacral Fractures: The Posterior Internal Fixator with a Minimum of Three Years of Follow-Up.

OBJECTIVE

It is a novel choice to have reduction and internal fixation for sacral fracture with iliac screws starting around the posterior superior iliac spine and percutaneously interconnected.

METHODS

This prospective work was performed at Ain Shams University Hospitals, Cairo, Egypt, during the period from January 2013 until January 2016. Fifty consecutive cases of longitudinal fractures of the sacrum were treated surgically using ileoileal fixation via minimal-access surgery.

RESULTS

According to Pohlemann clinical score, 42 patients (84%) were rated to have excellent clinical result, 6 patients (12%) had a good clinical result, and 2 patients (4%) had a fair clinical result. Regarding social scoring, 34 patients returned back to their jobs with the same level of effort and recreational activities (68%). Ten patients returned to work but with changes in their capabilities and decreases in recreational activities (20%). Six patients changed their profession to another one that required less effort (12%). Regarding radiologic scores, 15 patients (30%) had maximum radiologic scoring (excellent), 30 patients (60%) had good, and 5 patients (10%) had fair reduction. In total, 33 patients (66%) had an excellent final result (10/10); 9 patients (18%) had a good final result (9/10), and 8 patients (16%) had a fair result (7-8/10).

CONCLUSIONS

Fractures of the sacrum are challenging injuries regarding methods of fixation, choice of surgical approach, and the possibility of postoperative complications. Minimal-access ileoileal fixation provides a safe, rapid, and easy method for the fixation of such fractures. It is suitable for critical patients, as it is fast and performed with minimal blood loss. Also, because it does not require an image intensifier, it can be used in least-equipped situations, such as in war scenarios.