|
Year |
2005 |
|---|---|
|
Question Number |
32. |
|
Category |
Musculoskeletal Trauma |
Question
Which of the following internal fixation constructs for sacral fractures has the greatest stiffness when used for an unstable sacral fracture?
1- Single iliosacral screw
2- Two iliosacral screws
3- Triangular osteosynthesis (combination of iliosacral and lumbopelvic fixation)
4- Dorsal tension band plating
5- Transiliac bars
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Answer (click for answer)
PREFERRED RESPONSE: 3
When treating these fractures operatively, the surgeon has three goals in mind: (a) to reconstruct the anatomy, (b) to decompress the nerves, and (c) to create stable internal fixation. Anterior plate fixation in Tile type C pelvic ring fractures alone often results in inadequate stability. External fixation in its many variations is a viable pelvis stabilization technique only if vital parameters and organ functions do not allow definite reduction and fixation. Other established operative procedures include iliosacral screw osteosynthesis, transiliac rod fixation,transiliac plating, and local plate osteosynthesis.These techniques share a common benefit: they allow early, albeit limited, mobilization (usually partial weight-bearing) provided associated injuries do not impact patient mobility. None of these techniques provide adequate fixation for early unrestricted weight-bearing status.
In this retrospective study all (N=34)patients underwent triangular osteosynthesis using a combination of a vertical vertebro-pelvic distraction osteosynthesis (pedicle screw system) and a transverse fixation of the sacrum fracture with either iliosacral screws or trans-sacral plating. Immediate postoperative weight-bearing was permitted postoperatively. Triangular osteosynthesis, which is a combination of lumbopelvic distraction osteosynthesis and transverse fixation of the sacral fracture, was introduced as a new operative concept to allow immediate full weight-bearing in Type C pelvic ring injuries
Reference: RECOMMENDED READINGS: Schildhauer TA, Ledoux WR, Chapman JR, et al: Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: A cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma 2003;17:22-31.