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Corresponding Author

Hesham Habba, MD.

Authors ORCID

0000-0002-3415-1005

Subject Area

Lumbosacral spine, Surgical techniques, Trauma

Article Type

Original Study

Abstract

Background Data: Surgical management for sacral fractures is usually recommended in the presence of instability, dislocation, and neurological deficit. Operative approaches can be classified into two primary entities: posterior pelvic fixation approaches and lumbopelvic fixation approaches. Surgical management of sacral fractures is challenging as it may be associated with a broad variety of complications.

Purpose: Evaluation of complications of surgical management of sacral fractures and to present our clinical expertise regarding complication avoidance in future cases.

Study Design: This is a prospective cohort study.

Patients and Methods: All patients with unstable sacral fractures according to the AO Spine sacral fractures classification system were recruited for this study. All patients underwent an operation at the Neurosurgery Department, Suez Canal University Hospital, through the period from 2016 to 2023. In total, 15 patients underwent stand-alone lumbopelvic fixation, while 30 patients underwent triangular osteosynthesis in the form of lumbopelvic fixation in addition to iliosacral screw. The following data were included in the study: demographic data (age and gender) and mechanism of trauma. Radiological studies included lumbosacral spine X-ray (AP and lateral views), pelvis X-ray (AP, lateral, inlet, and outlet views), and multislice 3D CT–scan lumbosacral spine and pelvis. Types of fractures were categorized according to the AO Spine sacral fractures classification system.

Results: A total of 45 cases were included in this study. Moreover, 24 (53.3%) patients were males and 21 (46.7%) were females. The mean age was 29. 8± 5.3 (range, 18–67). Reported causes of trauma were falls from height in 27 cases (60%), road traffic accidents in 16 cases (35.6%), and falls of hard objects on the pelvis in two cases (4.4%). Reported complications were as follows: superficial wound infection in three patients (6.7%)—two of them underwent conservative management, while the other patient underwent wound debridement. Deep vein thrombosis (DVT) was reported in one patient and managed well with anticoagulation therapy. One patient had pelvic retroperitoneal hematoma postoperative and underwent conservative treatment. One patient underwent revision surgery for a loosened cross-link. Two patients had misdirected iliosacral screws violating the neural canal, with one patient who underwent screw removal.

Conclusion: Complications of surgical treatment of sacral fractures were, in general, minor and avoidable. Surgeon awareness of their importance and diversity is mandatory during planning surgery.

Keywords

Sacral fracture, Complications, Spinopelvic fixation, Triangular osteosynthesis, Iliosacral screw fixation

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