Double locking plate fixation of sacral fractures in unstable pelvic ring C-type injuries

Alternative sacrum fixation with double-plate osteosynthesis in vertical unstable pelvic fractures. The surgical technique allows anatomic reduction and osteosynthesis of the sacrum component.

All vertical unstable pelvic ring fractures 61-C type according to AO/OTA system with associated displaced sacrum fractures

Hemodynamic unstable patients, fractures with major sacroiliac joint involvement, nondisplaced sacrum fractures.

In prone position, a midline incision exposing the sacrum fracture is needed. The fracture is distracted and interjacent bone fragments or hematoma can be evacuated. The fracture is anatomically reduced and compressed. Two anatomically bent 3.5-mm locked compression plates (LCP) are placed on the dorsal aspect of the sacrum. In Denis type II and III fractures, the lateral screws can be placed in the lateral aspect of the sacrum. In Denis type I fractures, the lateral screws are placed in the ilium lateral to the sacroiliac joint to improve purchase. Additional short monocortical locking screws in the middle part of the plates increase the vertical stability to the osteosynthesis. Fracture fixation of the anterior ring follows the dorsal procedure.

The patient is mobilized with partial weight bearing. Clinical and radiological follow-up is planned after 6 and 12 weeks.

A total of 27 patients with vertical unstable pelvic fractures were identified and treated with open reduction and double-plate osteosynthesis. The Iowa pelvic score was rated excellent in 83 % and good in 17 % of cases. One patient developed a nonunion and had to be revised.