Lumbopelvic fixation with S2 alar-iliac screws for U-shaped sacral fractures

Yangxing Luo; Yue Li; Li He; Enzhi Yin; Meiqi Gu; Zhe Xu; Hua Chen; Zhiyong Hou; Chengla Yi

doi:10.1016/j.injury.2022.02.022

Lumbopelvic fixation with S2 alar-iliac screws for U-shaped sacral fractures

Injury. 2023 Apr:54 Suppl 2:S8-S14. doi: 10.1016/j.injury.2022.02.022. Epub 2022 Feb 11.

Authors

Yangxing Luo¹, Yue Li¹, Li He¹, Enzhi Yin¹, Meiqi Gu¹, Zhe Xu¹, Hua Chen², Zhiyong Hou³, Chengla Yi⁴

Affiliations

¹ Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
² Department of Orthopaedic Trauma, Chinese PLA General Hospital (301 Hospital), Beijing 100853, China.
³ Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China.
⁴ Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. Electronic address: chenglayi@163.com.

PMID: 35180997
DOI: 10.1016/j.injury.2022.02.022

Abstract

Objective: To investigate the surgical methods and clinical effects of lumbopelvic fixation (LPF) with S2 alar-iliac (S2AI) screws for U-shaped sacral fractures.

Methods: From December 2019 to August 2020, 14 patients with U-shaped sacral fractures were treated with LPF using S2AI screws. Demographics, fracture classification, mechanism of injury, surgical treatment, complications and clinical results were assessed. All patients had a LPF with or without nerve decompression. The reduction quality was evaluated according to the Matta criteria. Neurological function was evaluated according to the Gibbons grading. The activities of daily life were evaluated according to the Majeed scoring system at the last follow-up.

Results: Among 14 consecutive patients with U-shaped sacral fractures, the age at injury ranged from 13 to 72 years (average 30.3 ± 17.5 years). There were 4 males and 10 females. All patients were followed up for 6-15 months (average 7.8 ± 2.7 months). Thirteen patients were fixed with bilateral S2AI screws, and one patient was fixed only unilaterally due to unilateral spinopelvic dissociation. The excellent and good rate of postoperative pelvic reduction quality was 92% (excellent 10, good 3, fair 1). At the latest follow-up, the excellent and good rate of pelvic function was 100% (excellent 9, good 5) and all patients achieved different extents of neurological recovery. One patient had a postoperative superficial surgical site infection, which healed after debridement. Radiological examination at 3-6 months after operation showed that all fractures had healed. No complications were found in any patients during follow-up, such as implant fracture, loss of reduction, deep wound infection, wound dehiscence and screw protrusion discomfort.

Conclusion: LPF with S2AI screws for the treatment of U-shaped sacral fractures has exhibited distinct advantages, including firm fixation, a low rate of surgical site complications and satisfactory clinical efficacy. This approach provides sufficient stability to accelerate the commencement of postoperative rehabilitation.

Keywords: Lumbopelvic fixation; S2 alar-iliac screws; U-shaped sacral fractures.

MeSH terms

Adolescent
Adult
Aged
Bone Screws
Female
Fracture Fixation, Internal / methods
Fractures, Bone* / diagnostic imaging
Fractures, Bone* / etiology
Fractures, Bone* / surgery
Humans
Male
Middle Aged
Neck Injuries* / etiology
Radiography
Spinal Fractures* / diagnostic imaging
Spinal Fractures* / etiology
Spinal Fractures* / surgery
Treatment Outcome
Young Adult