TRIANGULAR OSTEOSYNTHESIS OF VERTICALLY UNSTABLE SACRUM FRACTURES - ANEW CONCEPT ALLOWING EARLY WEIGHT-BEARING

Objective: Presentation of a new triangular osteosynthesis technique t hat permits early weight-bearing in vertically unstable sacral fractur es. Design: Retrospective evaluation of a consecutive series. Setting: Level I trauma center. Patients: Thirty-four patients, twenty-eight o f whom were polytraumatized, all with Vertically unstable sacral fract ures. This group included eight women and twenty-six men, with a mean age of thirty-five years. Average time between trauma and definite ope ration was thirteen days (range 0 to 28 days). Interventions: All pati ents underwent triangular osteosynthesis using a combination of a vert ical vertebropelvic distraction osteosynthesis (pedicle screw system) and a transverse fixation of the sacrum fracture with either iliosacra l screws or transsacral plating. Immediate postoperative weight-bearin g was permitted postoperatively. Results: Nineteen patients were treat ed with early progressive weight-bearing and advanced to full weight-b earing, on average, after twenty-three days (range 8 to 70 days). Thre e of the thirty-four patients (9 percent) experienced loosening of har dware, including two patients (6 percent) who required secondary inter vention because of loss of the original reduction. Further complicatio ns included one pulmonary embolism (3 percent), one iatrogenic nerve l esion (3 percent), one wound necrosis (3 percent), and two local infec tions (6 percent). Conclusions: Triangular osteosynthesis is a demandi ng procedure that can be performed on vertically unstable sacral fract ures to allow early progressive weight-bearing with an acceptable comp lication rate.