Unstable pelvic ring injuries are relatively uncommon and occur as a result of high-energy trauma, and are associated with transverse fractures and dislocation of sacrum and sacroiliac joint(s) [Citation1,Citation2].
These injuries and specifically sacroiliac dislocations and vertically unstable sacral fractures have a significant impact on patient’s quality of life [Citation3]. In the past decades, most of the pelvic fractures were treated with skeletal traction and bed rest, because of lack of proper surgical techniques and appropriate fixation devices, which were followed by uncertain surgical and functional outcomes.
The contemporary treatment of these injuries has been changed towards early fixation and early mobilization [Citation4]. Posterior vertical pelvic ring instability is currently a clear indication for stabilization. Different surgical techniques (iliosacral screws, anterior or posterior sacroiliac plates, trans-iliac treated compression rods, open and MIS sacroiliac screw fixation, and sacroiliac fixation using a sacral screw and Galveston technique) are available for fixation of sacroiliac joint fractures and fracture-dislocations [Citation5–8]. Obviously, each method has its own advantages and disadvantages, and should be individualized depending on the particular patient’s situation [Citation4]. However, fixation of these injuries remains challenging, as a result of complex local anatomy, unique biomechanics, and poor bone quality.
The authors of this retrospective clinical series compared two surgical techniques for lumbopelvic fixation of selected unstable unilateral sacral fractures: the lumbopelvic fixation with pedicle and iliac screw (Group A) versus a “novel”, described by these authors technique, of the so-called adjustable plate (Group B)
The authors have compared surgical time, blood loss, intraoperative fluoroscopy time, reduction quality, and complications as well sacral fracture bone union. The Majeed score was used for functional outcome evaluation. The authors reported similar blood loss and intraoperative fluoroscopy, but less surgical time in the patients of group B who were operated with the “novel” technique. All sacral fractures showed completed bone healing, while no difference in the time of fracture healing was noted between the two groups. The rate of sufficient sacral fracture reduction, functional outcome and complication rate did not differ between the two groups.
I congratulate the authors for their effort to establish an innovative method of adequate fixation of unilateral sacral fractures. It is obvious that the “novel” adjustable plate presented in this article represents a new less invasive surgical technique comparable with lumbopelvic fixation with the advantages of shorter surgical time and less radiation. However, there are some limitations in this study: (1) This article reports on the preliminary clinical and radiological results and therefore a biomechanical study is needed to objectively assess the quality of fixation provided by this novel technique; (2) As this is a retrospective study, the selection criteria for the patients to be included in group A or B are biased; and (3) Selection of less complicated cases by the authors, which are those who actually need quick and safe surgery for early mobilization. More detailed, from the 112 patients, who were admitted with unilateral sacral fractures, patients with osteoporosis, open fractures, smokers etc. were excluded. Then 81 patients, who were operatively treated by the authors, 31 were operated with different other methods (iliosacral screws, plate, etc.) and excluded from this study and 50 operated with the two techniques that were compared in this article. This diversity of operative techniques makes depicts some uncertainty as regard surgical method selection.
Prospective randomized controlled trial with longer follow-up should be performed in the future to further explore the possible advantages of the novel technique over the lumbopelvic fixation.
Declaration of interest
The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article.
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