Standalone percutaneous transiliac plating of vertically unstable sacral fractures: outcomes, complications, and recommendations.

PURPOSE: The aim of this study is to evaluate results of a standalone percutaneous posterior plating of the vertically unstable sacral fractures, to analyze the influencing factors, to discuss encountered complications, and to express the related recommendations.

METHODS

Forty two cases were included; all of them had type C vertical sacral fractures; and 16 cases had associated nerve roots injury. Subcutaneous 3.5-mm reconstruction plate was used in all cases, through vertical incisions in 28 cases and transverse incisions in 14 cases. Hannover pelvic outcome scoring system was implemented for results evaluation.

RESULTS

The mean follow-up period was 22.1 ± 7.5 months; the mean operative time was 43.3 ± 7 min; the mean surgical incision length was 4.6 ± 1.1 cm. 14 cases had excellent scores, 16 cases had good scores, 6 cases had fair scores, and 6 cases had poor scores. Younger age groups had significantly better outcome (P = 0.015), whereas the comminuted sacrum had significantly worse score (P = 0.041). Final residual posterior displacements significantly improved (P = 0.001) in comparison to the initial displacement. The nerve roots injury had final significant recovery (P = 0.012). Transverse skin incisions had subjectively significant satisfaction (P = 0.017).

CONCLUSIONS

Percutaneous 3.5-mm reconstruction plate is a good alternative to percutaneous iliosacral screws in vertically unstable sacral fractures; especially in the presence of contraindication to the latter. It is simple procedure with minimal incisions; short operative time; less radiological exposure; good mechanical stability; and less iatrogenic injuries.