Rx of Sacral Fxs: Lumbo - pelvic fixation

It is important to understand the biomechanics of sacral injuries. As seen in Image 1, sacral injuries tend to be a dissociation of the lumbar spine with a lumbosacral component from the rest of the sacrum. The objective is to restore the ability of the lumbar spine to transmit weight bearing force through the pelvis to the hip joints and then distally through the lower extremities.

Lumbopelvic fixation (Images 2-4) addresses this requirement by providing spinal L4, L5, S1 pedicle screw fixation which can then transmit the weight bearing force to iliac screws anchored in the pelvis - thereby bypassing the unstable sacral segment.

Indications

• ? Zone II vertical Fx ?
• High grade Zone III Fx

Methods

• Midline exposure
• Segmental fixation L5/S1 to each iliac wing

Outcomes

• Infection 5%
• Neuro deterioration 0%
• Fracture union 100%
• Pain 25% (estimated)