Session VII - Pelvis

Fri., 10/6/06 Pelvis, Paper #35, 3:06 pm

Complications and Pitfalls Associated with Vertically Unstable Transforaminal Sacral Fractures Treated with Spinal Pelvic Fixation

H. Claude Sagi, MD (*); Troy H. Caron, DO (*);
Florida Orthopaedic Institute, Tampa, Florida, USA

Purpose: Our objective was to report on the complications and technical problems that have occurred with spinal pelvic fixation.

Methods: Patients with vertically unstable pelvic injuries associated with transforaminal sacral fractures were treated with spinal pelvic fixation. Maintenance of reduction was assessed by a standardized measurement ratio method using serial anteroposterior, inlet, and outlet views of the pelvis. CT scanning was performed on all patients at 6 months to assess healing of the fracture. If the fracture was healed, the fixation was removed routinely in all patients. Functional outcome was assessed with the SF-36 and MFA questionnaires. This analysis focused on the complications and technical problems associated with this technique of fixation after 1-year minimum follow-up.

Results: 25 patients with an average age of 36 years were available with a minimum 1-year follow-up. Wound complications requiring surgical debridement occurred in 16% of patients. Iatrogenic nerve injury occurred in 15%. Three patients had a delayed union and one patient had a nonunion requiring bone grafting. Although the other fractures had "healed", incomplete bridging was noted in many. Three patients were noted to have tilting of the L5 vertebral body and distraction of the L5/S1 facet joint ipsilateral to the fixation. This did not correct with removal of the fixation. Fixation failure occurred in 20% of patients. Painful hardware was present in 84%.

Conclusion/Significance: Although spinal pelvic fixation is a reliable form of fixation for preventing loss of reduction in transforaminal sacral fractures, close long-term follow-up and analysis of these patients shows a substantial rate of technical problems and complications. Of primary concern are the delayed/nonunions, asymmetric L5 tilting, and need for a second surgery in all patients to remove painful fixation. We recommend guarded use of this technique for transforaminal sacral fractures only.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.