Surgical Fixation of Geriatric Sacral U-Type Insufficiency Fractures: A Retrospective Analysis
Benjamin R Pulley1, Steven B Cotman2, T Ty Fowler2,3
1Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA.
Objectives:
To define the incidence of sacral U-type insufficiency fracture and describe management of a consecutive series of patients with this injury.
Design:
Retrospective analysis.
Setting:
Single Level II trauma center.
Patients/Participants:
Sixteen adult patients with sacral U-type insufficiency fractures treated over a 36-month period.
Intervention:
Patients were indicated for percutaneous screw fixation of the posterior pelvis if they had posterior pelvic pain that prohibited mobilization.
Main Outcome Measurements:
Visual analog scale for pain, distance ambulated on postoperative day 1, and change in sacral kyphosis.
Results:
The sacral U-type insufficiency fracture incidence was 16.7% (19/114); average patient age was 75 years. Delayed surgery was performed after primary nonoperative treatment had failed in 62.5% (10/16) at an average 83 days postinjury. Acute surgery was performed in 37.5% (6/16) at an average 5 days postinjury. Distance ambulated on postoperative day 1 was 114.4 feet [95% confidence interval (CI) (50.6, 178.2)] and 88.7 feet [95% CI (2.8, 174.6)] in the delayed and acute surgery groups, respectively, P = 0.18. Change in visual analog scale for pain was -3.2 [95% CI (-5.0, -1.4)] and -3.7 [95% CI (-7.0, -0.4)] in the delayed and acute surgery groups, respectively, P = 0.15. Change in sacral kyphosis from presentation to surgery was 12.3 degrees [95% CI (6.7, 17.9)] and 0.3 degrees [95% CI (-0.2, 0.9)] in the delayed and acute surgery groups, respectively, P < 0.01. Minimum follow-up was 12 months.
Conclusions:
Treatment of sacral U-type insufficiency fractures by percutaneous screw fixation permits early mobilization, provides rapid pain relief, and prevents progressive deformity.
Level Of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Related Concept Videos
01:13Insufficient Sleep and Sleep Deprivation
Sleep deprivation is a more severe form of sleep loss...
01:15Drug Dosing: Geriatric Patients
01:03Fixation and Sectioning
The simplest type of preparation is the wet mount, in which the specimen is placed in a drop of liquid on the slide. A liquid specimen can be directly deposited on the slide using a dropper. Solid specimens, such as skin scraping, can be placed on the slide before adding a drop of liquid to prepare the wet mount. Sometimes the liquid is simply water, but stains are often added...
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:28Carbon-dioxide Fixation