Osteosynthesis in sacral fracture and lumbosacral dislocation

Area of Science:

• Orthopedic Surgery
• Traumatology
• Neurosurgery

Background:

• Sacral fractures and lumbosacral hinge trauma are rare but severe injuries.
• Neurologic deficits frequently accompany these injuries, often necessitating nerve release.
• Effective management hinges on understanding fracture patterns, reduction techniques, and fixation strategies.

Purpose of the Study:

• To detail the analysis and classification of sacral fractures and lumbosacral hinge trauma.
• To elucidate technical pitfalls in reduction and fixation procedures.
• To outline current treatment indications for these complex injuries.

Main Methods:

• Review and application of three key classifications: Roy-Camille, Denis, and Tile.
• Discussion of surgical positioning, including orthopedic table use.
• Analysis of osteosynthesis techniques (lumbopelvic, pelvic ring, open vs. closed).

Main Results:

• Classification systems aid in understanding fracture lines, displacement, and neurologic risk.
• Surgical treatment involves precise patient positioning and reduction maneuvers based on classification.
• Distinguishing isolated sacral fractures from those with pelvic ring lesions is critical.
• Osteosynthesis options include lumbopelvic or pelvic ring fixation.
• Cementoplasty is indicated for fatigue or osteoporotic fractures with minimal displacement.
• Lumbosacral hinge trauma with dislocation requires reduction surgery and 360° fixation.

Conclusions:

• Accurate classification is paramount for guiding treatment of sacral fractures and lumbosacral hinge trauma.
• Surgical management requires meticulous technique, with potential for frequent complications and uncertain neurologic recovery.
• Specific indications exist for cementoplasty and 360° fixation in relevant sacral and lumbosacral injuries.