CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(03): 304-309
DOI: 10.1055/s-0039-3402474
Artigo Original
Coluna
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Complex Fractures of the Sacrum with Spinopelvic Dissociation Treated Surgically with Iliolumbar Fixation[*]

Article in several languages: português | English
1   Grupo de Cirurgia da Coluna, Hospital do Trabalhador, Curitiba, PR, Brasil
,
Xavier Soler I Graells
1   Grupo de Cirurgia da Coluna, Hospital do Trabalhador, Curitiba, PR, Brasil
2   Departamento de Ortopedia e Traumatologia, Hospital das Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brasil
,
André Luis Sebben
1   Grupo de Cirurgia da Coluna, Hospital do Trabalhador, Curitiba, PR, Brasil
,
Marcel Luiz Benato
1   Grupo de Cirurgia da Coluna, Hospital do Trabalhador, Curitiba, PR, Brasil
,
Pedro Grein Del Santoro
1   Grupo de Cirurgia da Coluna, Hospital do Trabalhador, Curitiba, PR, Brasil
,
Álynson Larocca Kulcheski
1   Grupo de Cirurgia da Coluna, Hospital do Trabalhador, Curitiba, PR, Brasil
› Author Affiliations
Further Information

Publication History

23 October 2018

12 March 2019

Publication Date:
25 June 2020 (online)

Abstract

Objective To analyze a series of cases of complex fractures of the sacrum with spinopelvic dissociation surgically treated with iliolumbar fixation, and to review the existing medical literature.

Methods For the analysis, the medical records of the cases operated using the Schildhauer et al technique for fixation were retrospectively evaluated, and followed up for at least 12 months. The functional results were assessed using the visual analog scale (VAS) for pain and the Oswestry disability index, version 2.0. The data were compared with those of the existing medical literature.

Results Six cases were analyzed, four of which evolved with moderate disability, one, with minimal disability, and one, with severe disability. Three cases that presented neurological deficits obtained significant improvement. Only one case evolved with pulmonary thromboembolic complications.

Conclusion The Schildhauer et al technique is an efficient technique for the fixation of complex sacral fractures with spinopelvic dissociation. The patients evolved with good functional results. Early weight-bearing has been shown to be safe with the use of this treatment.

* Work developed at the Spinal Surgery Group, Hospital do Trabalhador, Curitiba, PR, Brazil.


 
  • Referências

  • 1 Keith DW. Fractures, dislocations, and fracture-dislocations of the spine. In: Canale ST, Beaty JH. , editors. Campbell's operative orthopaedics. 12th ed. Canada: Elsevier; 2013: 1559-1627
  • 2 Vilela MD, Jermani C, Braga BP. Lumbopelvic fixation and sacral decompression for a U-shaped sacral fracture: case report. Arq Neuropsiquiatr 2007; 65 (3B): 865-868
  • 3 Bellabarba C, Schildhauer TA, Chapman JR. Sacral frantures. In: Herkowitz HN, Garfin SR, Eismont FJ, Bell GR, Balderston RA. , editors. Rothman-Simeone The spine. 6th ed. Philadelphia: Saunders/Elsevier; 2013: 1405-1421
  • 4 Schroeder GD, Savage JW, Patel AA, Stover MD. Spinopelvic fixation in complex sacral fractures. JBJS Rev 2015; 3 (03) e4
  • 5 Vaccaro AR, Kim DH, Brodke DS. , et al. Diagnosis and management of sacral spine fractures. Instr Course Lect 2004; 53 (01) 375-385
  • 6 Sacral Trauma [acesso em 2018 abril 18]. Disponível em: https://www2.aofoundation.org/wps/portal/surgerymobile?showPage=diagnosis&bone=Spine&segment=TraumaSacrum
  • 7 Schildhauer TA, Ledoux WR, Chapman JR, Henley MB, Tencer AF, Routt Jr ML. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma 2003; 17 (01) 22-31
  • 8 Rhee WT, You SH, Jang YG, Lee SY. Lumbo-sacro-pelvic fixation using iliac screws for the complex lumbo-sacral fractures. J Korean Neurosurg Soc 2007; 42 (06) 495-498
  • 9 Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25 (22) 2940-2952 , discussion 2952
  • 10 Maynard Jr FM, Bracken MB, Creasey G. , et al; American Spinal Injury Association. International Standards for Neurological and Functional Classification of Spinal Cord Injury. Spinal Cord 1997; 35 (05) 266-274
  • 11 Ise S, Abe K, Orita S. , et al. Surgical treatment for far-out syndrome associated with abnormal fusion of the L5 vertebral corpus and L4 hemivertebra: a case report. BMC Res Notes 2016; 9: 329
  • 12 Rocha VM, Guimarães JA, Olivaes Filho AP. , et al. Sacral fracture treatment with a variation of the lumbopelvic fixation technique. Coluna/Columna 2018; 17 (01) 69-73
  • 13 Bucholz RW, Heckman JD, Court-Brown CM, Torneta 3rd. P. Rockwood and Green's Fractures in adults. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2009
  • 14 Lee SW, Ko SB, Shin DY. Sacral Fracture Dislocation of Suicidal Jumper (Suicidal Jumper's Fracture) - 4 Cases Report -. J Korean Soc Spine Surg 2008; 15 (04) 281-285
  • 15 Roy-Camille R, Saillant G, Gagna G, Mazel C. Transverse fracture of the upper sacrum. Suicidal jumper's fracture. Spine 1985; 10 (09) 838-845
  • 16 König MA, Jehan S, Boszczyk AA, Boszczyk BM. Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies. Eur Spine J 2012; 21 (05) 829-836
  • 17 Schildhauer TA, Bellabarba C, Nork SE, Barei DP, Routt Jr ML, Chapman JR. Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation. J Orthop Trauma 2006; 20 (07) 447-457
  • 18 Kaye ID, Yoon RS, Stickney W, Snavely J, Vaccaro AR, Liporace FA. Treatment of Spinopelvic Dissociation: A Critical Analysis Review. JBJS Rev 2018; 6 (01) e7
  • 19 Ueno FH, Pisani MJ, Machado AN, Rodrigues FL, Fujiki EN, Rodrigues LMR. Estudo biomecânico da fixação da fratura sacroilíaca com barras de titânio e parafusos pediculares. Acta Ortop Bras 2015; 23 (03) 154-157
  • 20 Guimarães RP, Ribeiro AG, Ulson O, Ávila RB, Ono NK, Polesello GC. Tratamento das lesões instáveis do anel pélvico com fixador supra-acetabular e parafusos sacroilíacos: Resultados preliminaries em 20 pacientes. Rev Bras Ortop 2016; 51 (02) 132-137
  • 21 Sagi HC. Technical aspects and recommended treatment algorithms in triangular osteosynthesis and spinopelvic fixation for vertical shear transforaminal sacral fractures. J Orthop Trauma 2009; 23 (05) 354-360