Triangular Osteosynthesis of Vertically Unstable Sacrum Fractures: a New Concept Allowing Early Weight-bearing

Objective: Presentation of a new triangular osteosynthesis technique that permits early weight-bearing in vertically unstable sacral fractures.

Design: : Retrospective evaluation of a consecutive series.

Setting: Level I trauma center.

Patients: Thirty-four patients, twenty-eight of whom were poly-traumatized, all with vertically unstable sacral fractures. This group included eight women and twenty-six men, with a mean age of thirty-five years. Average time between trauma and definite operation was thirteen days (range 0 to 28 days).

Interventions: All patients underwent triangular osteosynthesis using a combination of a vertical vertebro-pelvic distraction osteosynthesis (pedicle screw system) and a transverse fixation of the sacrum fracture with either iliosacral screws or trans-sacral plating. Immediate postoperative weight-bearing was permitted postoperatively.

Results: Nineteen patients were treated with early progressive weight-bearing and advanced to full weight-bearing, on average, after twenty-three days (range 8 to 70 days). Three of the thirty-four patients (9 percent) experienced loosening of hardware, including two patients (6 percent) who required secondary intervention because of loss of the original reduction. Further complications included one pulmonary embolism (3 percent), one iatrogenic nerve lesion (3 percent), one wound necrosis (3 percent), and two local infections (6 percent).

Conclusions: Triangular osteosynthesis is a demanding procedure that can be performed on vertically unstable sacral fractures to allow early progressive weight-bearing with an acceptable complication rate.