6533b7d4fe1ef96bd126266b

RESEARCH PRODUCT

Transsacral Bar Osteosynthesis

subject

description

Uni- or bilateral sacral ala fractures in elderly persons may cause significant disability and result in non-union, if treated non-surgically. Transsacral positioning bar osteosynthesis provides the advantages of a minimally invasive approach yet reducing the risk of implant loosening. A threaded 6 mm bar is inserted through the posterior part of the ilium and the SI-joint, and advanced through the center of the S1 vertebral body towards the opposite posterior ilium. Washers and nuts are placed and tightened on both ends of the bar providing moderate compression of the vertical fracture planes in the sacrum. The stability of fixation does not depend on the bone mineral density of the sacrum, but on the strength of the outer cortex of the posterior ilium. A thorough preoperative analysis of the fracture morphology and the dimension of the transsacral corridor is paramount. The width of the transsacral corridor is measured in both transverse and coronal reconstructions of the pelvic CT-scan images. The sacral anatomy is highly variable showing in up to 35% signs of dysmorphism. The space for placing transsacral implants may then be very limited or even non-existing. Positioning of the patient, intraoperative imaging and the different steps of the surgical technique are explained in detail. The after-treatment protocol is depending of the underlying pathology. There is still little evidence about the clinical use of transsacral bar osteosynthesis. Three published studies showed a significant improvement in pain, need for analgesic medication, and function after early fixation of fragility fractures of the pelvis with a transsacral positioning bar. The complication rate was low. Further studies are needed to evaluate the technique and compare it with alternative fixation methods.