Multiplanar spinopelvic fracture reduction and dual triangular osteosynthesis stabilization for complex multiplanar sacropelvic fractures

Abstract

Background

Sacropelvic fractures with multidirectional instability require complex reduction and stabilisation techniques. Triangular osteosynthesis reconstruction is an established technique but hardware failure rates remain high and screw trajectories unfamiliar to spine surgeons. Our technique allows de-rotation of the pelvis, fracture reduction in both vertical and transverse planes, immediate weight bearing and is more reproducible for complex spine surgeons.

Objective

To describe our case series of dual triangular osteosynthesis reduction and stabilisation for complex sacropelvic fractures.

Methods

Retrospective case series of patients treated for unstable multiplanar sacropelvic fractures, at a level one trauma centre in the United Kingdom. Chart review was conducted to assess clinical features, radiology (plain radiographs, CT and MRI), surgical techniques and clinical and radiological outcomes.

Results

A total of six patients with four male and two females were included. Mean age of the cohort was 37.5 years (range 19–61 years) and average length of follow-up was 34.5 months (range 13–75 months). Three patients had neurological injury and three were intact. Four patients had associated thoraco-abdominal or lower limb injuries requiring intervention. All patients underwent surgery with reduction and stabilisation using dual triangular osteosynthesis constructs. At final follow-up, one patient had persistent bladder dysfunction (present preoperatively), one remained ASIA A from concomitant cord injury in the thoracic spine, and one patient with L5 and S1 weakness completely recovered. There were no metalwork complications and all patients achieved radiological fusion.

Conclusion

Our technique of reduction and stabilisation of complex multidirectional sacropelvic fractures leads to a biomechanically strong construct with immediate stability, and without risk of hardware failure.

Keywords:

• Spino-pelvic dissociation
• triangular fixation
• dual triangular osteosynthesis stabilization

Authors’ contributions

Siddharth Vankipuram was involved in the acquisition of data, initial draft preparation, critical analysis and subsequent revision upto submission. Pratipal Kalsi was involved in the acquisition of data, initial draft preparation and critical analysis. Grace Yang has completed the illustration and was involved in final revision. Vittorio Russo was involved in conception, study execution, critical analysis and final revision. Antonino Russo was involved in the conception, study execution, critical analysis and final revision.

Disclosure statement

The authors have no conflicts of interest to declare.