Sakrum Kırıklarının Değerlendirilmesi ve Tedavi Yöntemleri
Özet
Sakrum, vertebral kolon ile pelvik halka arasında yük aktarımını ve stabiliteyi sağlayan kritik bir yapıdır. Gençlerde yüksek enerjili, yaşlılarda ise düşük enerjili travmalarla oluşan sakrum kırıklarının insidansı, nüfusun yaşlanması ve bilgisayarlı tomografi (BT) kullanımının artmasıyla yükselmektedir. Tanı aşamasında düz grafiler yetersiz kalabilirken, BT ve manyetik rezonans görüntüleme (MRG) yüksek hassasiyet sunar. Kırıkların sınıflandırılmasında travmanın enerjisi, pelvik halka birlikteliği, morfoloji ve Denis zonları temel alınır; özellikle nöral kanalı etkileyen Zon III kırıklarda nörolojik hasar riski yüksektir. Tedavi yöntemi kırığın instabilitesine, deplasman miktarına ve nörolojik defisit varlığına göre belirlenir. Stabil kırıklar istirahat ve erken mobilizasyonla konservatif olarak izlenebilirken, instabil veya 10 mm'den fazla deplase kırıklar ile kauda ekina sendromu gibi durumlarda cerrahi fiksasyon gereklidir. Cerrahi yaklaşımlar posterior pelvik fiksasyon (iliosakral vidalar, transsakral implantlar) ve daha yüksek instabilitede tercih edilen lumbopelvik fiksasyon (triangular osteosentez) yöntemlerini içerir. Ameliyatlarda implant malpozisyonu, enfeksiyon ve sinir hasarı gibi komplikasyon riskleri bulunsa da uygun cerrahi fiksasyon ve dolaylı dekompresyon, hastaların fonksiyonel iyileşmesini ve mobilizasyonunu anlamlı düzeyde artırarak yaşam kalitesini optimize etmektedir.
The sacrum is a critical structure providing weight transfer and stability between the vertebral column and the pelvic ring. The incidence of sacral fractures, which occur due to high-energy traumas in young individuals and low-energy traumas in the elderly, is rising with an aging population and increased computed tomography (CT) utilization. While plain radiographs may be insufficient in diagnosis, CT and magnetic resonance imaging (MRI) offer high sensitivity. Classification is based on trauma energy, pelvic ring involvement, morphology, and Denis zones, with Zone III fractures affecting the neural canal carrying a high risk of neurological damage. The treatment method is determined by fracture instability, displacement amount, and the presence of neurological deficits. While stable fractures can be managed conservatively with rest and early mobilization, surgical fixation is required for unstable or more than 10 mm displaced fractures and conditions like cauda equina syndrome. Surgical approaches include posterior pelvic fixation (iliosacral screws, transsacral implants) and lumbopelvik fixation (triangular osteosynthesis) preferred in high instability. Although operations carry complication risks such as implant malposition, infection, and nerve damage, appropriate surgical fixation and indirect decompression significantly enhance the functional recovery and mobilization of patients, optimizing their quality of life.
Referanslar
van Berkel D, Ong T, Drummond A, et al. ASSERT (Acute Sacral inSufficiEncy fractuRe augmenTation) randomised controlled, feasibility in older people trial: a study protocol. BMJ Open 2019;9:e032111.
Bydon M, De la Garza-Ramos R, Macki M, Desai A, Gokaslan AK, Bydon A. Incidence of sacral fractures and in-hospital postoperative complications in the United States: an analysis of 2002–2011 data. Spine (Phila Pa 1976) 2014;39:E1103–E1109.
lyders EM, Whitlow Ct, Baker Md, Morris PP. Imaging and treatment of sacral insufficiency fractures. AJNR Am J Neuroradiol 2010;31:201–210.
Tamaki Y, Nagamachi A, Inoue K, et al. Incidence and clinical features of sacral insufficiency fracture in the emergency department. Am J Emerg Med 2017;35:1314–1316.
Rommens PM, Arand C, Hofmann A, Wagner D. When and how to operate fragility fractures of the pelvis? Indian J Orthop 2019;53:128–137.
Bydon M, Fredrickson V, De la Garza-ramos R, et al. Sacral fractures. Neurosurg Focus 2014;37:E12.
Beckmann NM, Chinapuvvula NR. Sacral fractures: classification and management. Emerg Radiol 2017;24:605–617.
Benzel EC: Spine Surgery: Techniques, Complication Avoidance, and Management, üçüncü baskı. Philadelphia: Elsevier Saunders, 2012
Schroeder GD, Kurd MF, Kepler CK, et al. The development of a universally accepted sacral fracture classification: a survey of AOSpine and AOTrauma members. Global Spine J 2016;6:686–694.
Sakaguchi M, Maebayashi T, Aizawa T, Ishibashi N. Risk factors for sacral insufficiency fractures in cervical cancer after whole pelvic radiation therapy. Anticancer Res 2019;39:361–367.
Vajapey s, Matic G, Hartz C, Miller TL. Sacral stress fractures: a rare but curable cause of back pain in athletes. Sports Health 2019;11:446–452.
Beckmann N, Cai C. CT characteristics of traumatic sacral fractures in association with pelvic ring injuries: correlation using the Young-Burgess classification system. Emerg Radiol 2017;24:255–262.
Park YS, Baek SW, Kim HS, Park KC. Management of sacral fractures associated with spinal or pelvic ring injury. J Trauma Acute Care Surg 2012;73:239–242.
Meinberg Eg, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma 2018;32:S1–S170.
Burgess AR, Eastridge BJ, Young JW, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 1990;30:848–856.
Rommens PM, Hofmann A. Comprehensive classification of fragility fractures of the pelvic ring: recommendations for surgical treatment. Injury 2013;44:1733–1744.
Katsuura Y, Lorenz E, Gardner W II. Anatomic parameters of the sacral lamina for osteosynthesis in transverse sacral fractures. Surg Radiol Anat 2018;40:521–528.
Backer HC, Wu CH, Vosseller Jt, et al. Spinopelvic dissociation in patients suffering injuries from airborne sports. Eur Spine J 2019. DOI: 10.1007/s00586-019-05983-6 [Epub ahead of print].
Tian W, Chen WH, Jia J. Traumatic spino-pelvic dissociation with bilateral triangular fixation. Orthop Surg 2018;10:205–211.
Lehmann W, Hoffmann M, Briem D, et al. Management of traumatic spinopelvic dissociations: review of the literature. Eur J Trauma Emerg Surg 2012;38:517–524.
Nonne D, Capone A, Sanna F, et al. Suicidal jumper’s fracture – sacral fractures and spinopelvic instability: a case series. J Med Case Rep 2018;12:186.
Pulley BR, Cotman SB, Fowler TT. Surgical fixation of geriatric sacral U-type insufficiency fractures: a retrospective analysis. J Orthop Trauma 2018;32:617–622.
Bakker G, Hattingen J, Stuetzer H, Isenberg J. Sacral insufficiency fractures: how to classify? J Korean Neurosurg Soc 2018;61:258–266.
Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 1988;227:67–81.
Wagner D, Kamer L, Sawaguchi T, Richards RG, Noser H, Rommens PM. Sacral bone mass distribution assessed by averaged three-dimensional CT models: implications for pathogenesis and treatment of fragility fractures of the sacrum. J Bone Joint Surg Am 2016;98:584–590.
Ruatti S, Guillot S, Brun J, et al. Which pelvic ring fractures are potentially lethal? Injury 2015;46:1059–1063.
Strange-Vognsen HH, Lebech A. An unusual type of fracture in the upper sacrum. J Orthop Trauma 1991;5:200–203.
Bishop JA, Dangelmajer S, Corcoran-Schwartz I, Gardner MJ, Routt MlC Jr, Castillo TN. Bilateral sacral ala fractures are strongly associated with lumbopelvic instability. J Orthop Trauma 2017;31:636–639.
Isler B. Lumbosacral lesions associated with pelvic ring injuries. J Orthop Trauma 1990;4:1–6.
Guerado E, Cervan AM, Cano JR, Giannoudis PV. Spinopelvic injuries: facts and controversies. Injury 2018;49:449–456.
Hanna TN, Sadiq M, Ditkofsky N, et al. Sacrum and coccyx radiographs have limited clinical impact in the emergency department. AJR Am J Roentgenol 2016;206:681–686.
Rodrigues-Pinto R, Kurd Mf, Schroeder GD, et al. Sacral fractures and associated injuries. Global Spine J 2017;7:609–616.
Kao FC, Hsu YC, Liu PH, Yeh LR, Wang JT, Tu YK. Osteoporotic sacral insufficiency fracture: an easily neglected disease in elderly patients. Medicine (Baltimore) 2017;96:e9100.
Sudhir G, K L K, Acharya S, Chahal R. Sacral insufficiency fractures mimicking lumbar spine pathology. Asian Spine J 2016;10:558–564.
Wagner D, Ossendorf C, Gruszka D, Hofmann A, Rommens PM. Fragility fractures of the sacrum: how to identify and when to treat surgically? Eur J Trauma Emerg Surg 2015;41:349–362.
Pascarella R, Del Torto M, Politano R, Commessatti M, Fantasia R, Maresca A. Critical review of pelvic fractures associated with external iliac artery lesion: a series of six cases. Injury 2014;45:374–378.
Halawi MJ. Pelvic ring injuries: surgical management and long-term outcomes. J Clin Orthop Trauma 2016;7:1–6.
Hatgis J, Granville M, Jacobson RE, Berti A. Sacral insufficiency fractures: recognition and treatment in patients with concurrent lumbar vertebral compression fractures. Cureus 2017;9:e1008.
Nork SE, Jones CB, Harding SP, Mirza SK, Routt Ml JR. Percutaneous stabilization of U-shaped sacral fractures using iliosacral screws: technique and early results. J Orthop Trauma 2001;15:238–246.
Mandell JC, Weaver MJ, Khurana B. Computed tomography for occult fractures of the proximal femur, pelvis, and sacrum in clinical practice: single institution, dual-site experience. Emerg Radiol 2018;25:265–273.
Schicho A, Schmidt SA, Seeber K, Olivier A, Richter PH, Gebhard F. Pelvic X-ray misses out on detecting sacral fractures in the elderly: importance of CT imaging in blunt pelvic trauma. Injury 2016;47:707–710.
Henes FO, Nüchtern JV, Groth M, et al. Comparison of diagnostic accuracy of magnetic resonance imaging and multidetector computed tomography in the detection of pelvic fractures. Eur J Radiol 2012;81:2337–2342.
Na WC, Lee SH, Jung S, Jang HW, Jo S. Pelvic insufficiency fracture in severe osteoporosis patient. Hip Pelvis 2017;29:120–126.
Baldwin MJ, Tucker LJ. Sacral insufficiency fractures: a case of mistaken identity. Int Med Case Rep J 2014;7:93–98.
Kinoshita H, Miyakoshi N, Kobayashi T, Abe T, Kikuchi K, Shimada Y. Comparison of patients with diagnosed and suspected sacral insufficiency fractures. J Orthop Sci 2019;24:702–707.
Yoder K, Bartsokas J, Averell K, McBride E, Long C, Cook C. Risk factors associated with sacral stress fractures: a systematic review. J Man Manip Ther 2015;23: 84–92.
Wang B, Fintelmann FJ, Kamath RS, Kattapuram SV, Rosenthal DI. Limited magnetic resonance imaging of the lumbar spine has high sensitivity for detection of acute fractures, infection, and malignancy. Skeletal Radiol 2016;45:1687–1693.
Lapina O, Tiškevičius S. Sacral insufficiency fracture after pelvic radiotherapy: a diagnostic challenge for a radiologist. Medicina (Kaunas) 2014;50:249–254.
Scheyerer MJ, Hüllner M, Pietsch C, Werner CM, Veit-Haibach P. Evaluation of pelvic ring injuries using SPECT/CT. Skeletal Radiol 2015;44:217–222.
Zhang L, He Q, Jiang M, Zhang B, Zhong X, Zhang R. Diagnosis of insufficiency fracture after radiotherapy in patients with cervical cancer: contribution of technetium tc 99m-labeled methylene diphosphonate single-photon emission computed tomography/computed tomography. Int J Gynecol Cancer 2018;28:1369–1376.
Hak DJ, Baran S, Stahel P. Sacral fractures: current strategies in diagnosis and management. Orthopedics 2009;32:orthosupersite.com/view.asp?rID=44034.
Gray R, Molnar R, Suthersan M. A minimally invasive surgical technique for the management of U-shape sacral fractures. Spinal Cord Ser Cases 2017;3:17045.
Hagen J, Castillo R, Dubina A, Gaski G, Manson TT, O’Toole RV. Does surgical stabilization of lateral compression-type pelvic ring fractures decrease patients’ pain, reduce narcotic use, and improve mobilization? Clin Orthop Relat Res 2016;474: 1422–1429.
Höch A, Schneider I, Todd J, Josten C, Böhme J. Lateral compression type B 2-1 pelvic ring fractures in young patients do not require surgery. Eur J Trauma Emerg Surg 2018;44:171–177.
Mahajan R, Tandon V, Das K, Nanda A, Venkatesh R, Chhabra HS. Management of neglected sacral fracture with cauda equina syndrome: report of two cases with review of literature. Spinal Cord Ser Cases 2015;1:15020.
Lehman RA Jr, Kang DG, Bellabarba C. A new classification for complex lumbosacral injuries. Spine J 2012;12:612–628.
Sommer C. Fixation of transverse fractures of the sternum and sacrum with the locking compression plate system: two case reports. J Orthop Trauma 2005;19:487–490.
Kasukawa Y, Miyakoshi N, Ebina T, et al. Enhanced bone healing and decreased pain in sacral insufficiency fractures after teriparatide treatment: retrospective clinical-based observational study. Clin Cases Miner Bone Metab 2017;14:140–145.
Baillieul S, Guinot M, Dubois C, Prunier A, Mahler F, Gaudin P. Set the pace of bone healing: treatment of a bilateral sacral stress fracture using teriparatide in a long-distance runner. Joint Bone Spine 2017;84:499–500.
Bederman SS, Hassan JM, Shah KN, Kiester PD, Bhatia NN, Zamorano DP. Fixation techniques for complex traumatic transverse sacral fractures: a systematic review. Spine (Phila Pa 1976) 2013;38:E1028–E1040.
Kanezaki S, Miyazaki M, Notani N, et al. Minimally invasive triangular osteosynthesis for highly unstable sacral fractures: technical notes and preliminary clinical outcomes. Medicine (Baltimore) 2019;98:e16004.
Vigdorchik JM, Jin X, Sethi A, et al. A biomechanical study of standard posterior pelvic ring fixation versus a posterior pedicle screw construct. Injury 2015;46:1491–1496.
Takao M, Hamada H, Sakai T, Sugano N. Factors influencing the accuracy of iliosacral screw insertion using 3D fluoroscopic navigation. Arch Orthop Trauma Surg 2019;139:189–195.
El Dafrawy MH, Strike SA, Osgood GM. Use of the S3 corridor for iliosacral fixation in a dysmorphic sacrum: a case report. JBJS Case Connect 2017;7:e62.
Höch A, Pieroh P, Henkelmann R, Josten C, Böhme J. In-screw polymethylmethacrylate-augmented sacroiliac screw for the treatment of fragility fractures of the pelvis: a prospective, observational study with 1-year follow-up. BMC Surg 2017;17:132.
König MA, Hediger S, Schmitt JW, Jentzsch T, Sprengel K, Werner CML. In-screw cement augmentation for iliosacral screw fixation in posterior ring pathologies with insufficient bone stock. Eur J Trauma Emerg Surg 2018;44:203–210.
Kortman K, Ortiz O, Miller T, et al. Multicenter study to assess the efficacy and safety of sacroplasty in patients with osteoporotic sacral insufficiency fractures or pathologic sacral lesions. J Neurointerv Surg 2013;5:461–466.
Lucas JF, Routt ML Jr, Eastman JG. A useful preoperative planning technique for transiliac-transsacral screws. J Orthop Trauma 2017;31:e25–e31.
Kobbe P, Hockertz I, Sellei RM, Reilmann H, Hockertz T. Minimally invasive stabilisation of posterior pelvic-ring instabilities with a transiliac locked compression plate. Int Orthop 2012;36:159–164.
Liuzza F, Silluzio N, Florio M, et al. Comparison between posterior sacral plate stabilization versus minimally invasive transiliac-transsacral lag-screw fixation in fractures of sacrum: a single-centre experience. Int Orthop 2019;43:177–185.
Dienstknecht T, Berner A, Lenich A, Nerlich M, Fuechtmeier B. A minimally invasive stabilizing system for dorsal pelvic ring injuries. Clin Orthop Relat Res 2011;469:3209–3217.
Salášek M, Jansová M, Křen J, Pavelka T, Weisová D. Biomechanical comparison of a transiliac internal fixator and two iliosacral screws in transforaminal sacral fractures: a finite element analysis. Acta Bioeng Biomech 2015;17:39–49.
Futamura K, Baba T, Mogami A, et al. ‘Within ring’-based sacroiliac rod fixation may overcome the weakness of spinopelvic fixation for unstable pelvic ring injuries: technical notes and clinical outcomes. Int Orthop 2018;42:1405–1411.
Zhang R, Yin Y, Li S, Guo J, Hou Z, Zhang Y. Sacroiliac screw versus a minimally invasive adjustable plate for Zone II sacral fractures: a retrospective study. Injury 2019;50:690–696.
Acklin YP, Marco G, Sommer C. Double locking plate fixation of sacral fractures in unstable pelvic ring C-type injuries. Oper Orthop Traumatol 2015;27:74–79.
Pascal-Moussellard H, Hirsch C, Bonaccorsi R. Osteosynthesis in sacral fracture and lumbosacral dislocation. Orthop Traumatol Surg Res 2016;102:S45–S57.
Williams SK, Quinnan SM. Percutaneous lumbopelvic fixation for reduction and stabilization of sacral fractures with spinopelvic dissociation patterns. J Orthop Trauma 2016;30:e318–e324.
Bourghli A, Boissiere L, Obeid I. Dual iliac screws in spinopelvic fixation: a systematic review. Eur Spine J 2019;28:2053–2059.
Mohd Asihin MA, Bajuri MY, Ahmad AR, Ganaisan PK, Fazir M, Salim AA. Spinopelvic fixation supplemented with gullwing plate for multiplanar sacral fracture with spinopelvic dissociation: a case series with short term follow up. Front Surg 2019;6:42.
Sagi HC, Militano U, Caron T, Lindvall E. A comprehensive analysis with minimum 1-year follow-up of vertically unstable transforaminal sacral fractures treated with triangular osteosynthesis. J Orthop Trauma 2009;23:313–319.
Song W, Zhou D, He Y. The biomechanical advantages of bilateral lumbo-iliac fixation in unilateral comminuted sacral fractures without sacroiliac screw safe channel: a finite element analysis. Medicine (Baltimore) 2016;95:e5026.
Acklin YP, Zderic I, Richards RG, Schmitz P, Gueorguiev B, Grechenig S. Biomechanical investigation of four different fixation techniques in sacrum Denis type II fracture with low bone mineral density. J Orthop Res 2018;36:1624–1629.
Mitchell PM, Corrigan CM, Patel NA, et al. 13-year experience in external fixation of the pelvis: complications, reduction and removal. Eur J Trauma Emerg Surg 2016;42:91–96.
Krappinger D, Lindtner RA, Benedikt S. Preoperative planning and safe intraoperative placement of iliosacral screws under fluoroscopic control. Oper Orthop Traumatol 2019;31:465–473.
Wang H, Fu YH, Ke C, et al. Minimally invasive stabilisation of posterior pelvic ring instabilities with pedicle screws connected to a transverse rod. Int Orthop 2018;42:681–686.
Kim JW, Oh CW, Oh JK, et al. The incidence of and factors affecting iliosacral screw loosening in pelvic ring injury. Arch Orthop Trauma Surg 2016;136:921–927.
Koshimune K, Ito Y, Sugimoto Y, et al. Minimally invasive spinopelvic fixation for unstable bilateral sacral fractures. Clin Spine Surg 2016;29:124–127.
El Dafrawy MH, Kebaish KM. Percutaneous S2 alar iliac fixation for pelvic insufficiency fracture. Orthopedics 2014;37:e1033–e1035.
Hopf JC, Krieglstein CF, Müller LP, Koslowsky TC. Percutaneous iliosacral screw fixation after osteoporotic posterior ring fractures of the pelvis reduces pain significantly in elderly patients. Injury 2015;46:1631–1636.
Maki S, Nakamura K, Yamauchi T, et al. Lumbopelvic fixation for sacral insufficiency fracture presenting with sphincter dysfunction. Case Rep Orthop 2019;2019: 9097876.
Konig MA, Jehan S, Boszczyk AA, Boszczyk BM. Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies. Eur Spine J 2012;5:829–836.
Strobl FF, Haeussler SM, Paprottka PM, et al. Technical and clinical outcome of percutaneous CT fluoroscopy-guided screw placement in unstable injuries of the posterior pelvic ring. Skeletal Radiol 2014;43:1093–1100.
Yang F, Yao S, Chen KF, et al. A novel patient-specific three-dimensional- printed external template to guide iliosacral screw insertion: a retrospective study. BMC Musculoskelet Disord 2018;19:397.
Zhang R, Yin Y, Li S, Li A, Hou Z, Zhang Y. Lumbopelvic fixation versus novel adjustable plate for sacral fractures: a retrospective comparative study. J Invest Surg 2019. DOI: 10.1080/08941939.2019.1569737 [Epub ahead of print].
Kang S, Chung PH, Kim JP, Kim YS, Lee HM, Eum GS. Superior gluteal artery injury during percutaneous iliosacral screw fixation: a case report. Hip Pelvis 2015;27: 57–62.
Yu YH, Lu ML, Tseng IC, et al. Effect of the subcutaneous route for iliac screw insertion in lumbopelvic fixation for vertical unstable sacral fractures on the infection rate: a retrospective case series. Injury 2016;47:2212–2217.
Xie YL, Cai L, Ping AS, Lei J, Deng ZM, Hu C, Zhu XB. Lumbopelvic fixation and sacral decompression for u-shaped sacral fractures: surgical management and early outcome. Curr Med Sci 2018;38:684–690.
Raza H, Bowe A, Davarinos N, Leonard M. Bowel preparation prior to percutaneous ilio-sacral screw insertion: is it necessary? Eur J Trauma Emerg Surg 2018;44: 211–214.
Osterhoff G, Noser J, Sprengel K, Simmen HP, Werner CML. Rate of intraoperative problems during sacroiliac screw removal: expect the unexpected. BMC Surg 2019;19:39.
Chen W, Hou Z, Su Y, Smith WR, Liporace FA, Zhang Y. Treatment of posterior pelvic ring disruptions using a minimally invasive adjustable plate. Injury 2013;44:975–980.
Andresen R, Radmer S, Andresen JR, Schober HC. Comparison of the 18-month outcome after the treatment of osteoporotic insufficiency fractures by means of balloon sacroplasty (BSP) and radiofrequency sacroplasty (RFS) in comparison: a prospective randomised study. Eur Spine J 2017;26:3235–3240.
Yang SC, Tsai TT, Chen HS, Fang CJ, Kao YH, Tu YK. Comparison of sacroplasty with or without balloon assistance for the treatment of sacral insufficiency fractures. J Orthop Surg (Hong Kong) 2018;26:2309499018782575.
Adelved A, Tötterman A, Glott T, Hellund JC, Madsen JE, Røise O. Long- term functional outcome after traumatic lumbosacral dissociation: a retrospective case series of 13 patients. Injury 2016;47:1562–1568.
Adelved A, Tötterman A, Glott T, Søberg HL, Madsen JE, Røise O. Patient-reported health minimum 8 years after operatively treated displaced sacral fractures: a prospective cohort study. J Orthop Trauma 2014;28:686–693.
Lindahl J, Mäkinen TJ, Koskinen SK, Söderlund T. Factors associated with outcome of spinopelvic dissociation treated with lumbopelvic fixation. Injury 2014;45: 1914–1920.
Khaled SA, Soliman O, Wahed MA. Functional outcome of unstable pelvic ring injuries after iliosacral screw fixation: single versus two screw fixation. Eur J Trauma Emerg Surg 2015;41:387–392.
Noser J, Dietrich M, Tiziani S, Werner CML, Pape HC, Osterhoff G. Mid-term follow-up after surgical treatment of fragility fractures of the pelvis. Injury 2018;49:2032–2035.
Loggers SAI, Joosse P, Jan Ponsen K. Outcome of pubic rami fractures with or without concomitant involvement of the posterior ring in elderly patients. Eur J Trauma Emerg Surg. 2019;45:1021-1029.
Eckardt H, Egger A, Hasler RM, et al. Good functional outcome in patients suffering fragility fractures of the pelvis treated with percutaneous screw stabilisation: assessment of complications and factors influencing failure. Injury 2017;48: 2717–2723.
Walker JB, Mitchell SM, Karr SD, Lowe JA, Jones CB. Percutaneous transiliac-transsacral screw fixation of sacral fragility fractures improves pain, ambulation, and rate of disposition to home. J Orthop Trauma 2018;32:452–456.
Boyoud-garnier L, Boudissa M, Ruatti S, Kerschbaumer G, Grobost P, Tonetti J. Chronic low back pain after lumbosacral fracture due to sagittal and frontal vertebral imbalance. Orthop Traumatol Surg Res 2017;103:523–526.
Lee HD, Jeon CH, Won SH, Chung NS. Global sagittal imbalance due to change in pelvic incidence after traumatic spinopelvic dissociation. J Orthop Trauma 2017;31: e195–e199.
Lee JS, Kim YH. Factors associated with gait outcomes in patients with traumatic lumbosacral plexus injuries. Eur J Trauma Emerg Surg. 2019. doi: 10.1007/s00068-019- 01137-x [Epub ahead of print].
Adelved A, Tötterman A, Hellund JC, Glott T, Madsen JE, Røise O. Radiological findings correlate with neurological deficits but not with pain after operatively treated sacral fractures. Acta Orthop 2014;85:408–414.
Bekmez S, Demirkıran G, Caglar O, Akel I, Acaroğlu E. Transverse sacral fractures and concomitant late-diagnosed cauda equina syndrome. Ulus Travma Acil Cerrahi Derg 2014;20:71–74.
Kepler CK, Schroeder GD, Hollern DA, et al. Do formal laminectomy and timing of decompression for patients with sacral fracture and neurologic deficit affect outcome? J Orthop Trauma 2017;31:S75–S80.
Bai Z, Gao S, Liu J, liang A, Yu W. Anatomical evidence for the anterior plate fixation of sacroiliac joint. J Orthop Sci 2018;23:132–136.
Theologis AA, Burch S, Pekmezci M. Placement of iliosacral screws using 3D image-guided (O-Arm) technology and stealth navigation: comparison with traditional fluoroscopy. Bone Joint J Br 2016;98-B:696–702.
Wang JQ, Wang Y, Feng Y, et al. Percutaneous sacroiliac screw placement: a prospective randomized comparison of robot-assisted navigation procedures with a conventional technique. Chin Med J (Engl) 2017;130:2527–2534.
Irifune H, Hirayama S, Takahashi N, Chiba M, Yamashita T. Closed reduction in a ‘hyperextended supine position’ with percutaneous transsacral-transiliac and iliosacral screw fixation for Denis zone III sacral fractures. Adv Orthop 2018;2018:6098510.
Ruatti S, Kerschbaumer G, Gay E, Milaire M, Merloz P, Tonetti J. Technique for reduction and percutaneous fixation of U- and H-shaped sacral fractures. Orthop Traumatol Surg Res 2013;99:625–629.
Peng Y, Zhang W, Zhang G, et al. Using the Starr Frame and Da Vinci surgery system for pelvic fracture and sacral nerve injury. J Orthop Surg Res 2019;14:29.
Fujino S, Miyagi M, Tajima S, et al. Surgical treatment for suicidal jumper’s fracture (unstable sacral fracture) with thoracolumbar burst fracture: a report of three cases. Spine Surg Relat Res 2017;1:100–106.
Okuda A, Maegawa N, Matsumori H, et al. Minimally invasive spinopelvic ‘crab-shaped fixation’ for unstable pelvic ring fractures: technical note and 16 case series. J Orthop Surg Res 2019;14:51.
