Journal of Musculoskeletal Trauma

Fragility Fractures of the Pelvis and Sacrum: Se-Won Lee, Ju-Yeong Kim; J Korean Fract Soc 2023;36(1):29-38. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.29

Abstract PDF: The incidence of fragility fractures of the pelvis (FFP) has increased significantly due to the aging popu-lation and improved diagnostic modalities. The evaluation and treatment of these patients differ from that of high-energy pelvic ring injuries typically seen in younger patients. Therefore, it is important to classify the FFP by patterns of the classification system to standardize optimal treatment criteria and appropriate treatment strategy. However, some cases are not classifiable according to the FFP classifi-cation. A newly proposed classification that can be verified by comparing existing FFP classifications is needed to overcome the weak points. Non-operative treatment is usually considered first and should focus on early mobilization. Operative fixation should focus on stabilizing the minimally invasive pelvic ring than the reduction of fractures to facilitate early mobilization and avoid complications that can arise from comorbidities associated with immobility.

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Percutaneous Iliosacral Screw Fixation with Cement Augmentation in Osteoporotic Sacral Fracture: Cheol hwan Kim, Young yool Chung, Seung woo Shim, Sung nyun Baek, Choong young Kim; J Korean Fract Soc 2019;32(4):165-172. Published online October 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.4.165

Abstract PDF: PURPOSE
The prevalence of osteoporotic sacral fractures is increasing. Traditionally, conservative treatment is the 1st option, but it can increase the risk of comorbidity in the elderly. To reduce the complications and allow early mobility, iliosacral screw fixation with cement augmentation will be one of the treatment options for patients with osteoporotic sacral fractures.
MATERIALS AND METHODS
This study reviewed 25 patients (30 cases) who had undergone percutaneous iliosacral screw fixation with cement augmentation for osteoporotic sacral fractures from July 2012 to December 2018 with a minimum follow up of six months. The clinical outcomes were assessed using the measures of pain (visual analogue scale [VAS] score), hospital stay and the date when weight-bearing started. All patients were evaluated radiologically for pull-out of screw, bone-union, and cement-leakage.
RESULTS
Bone union was achieved in 30 cases (100%). The mean duration of the hospital stay was 24 days (4â€“66 days); weight-bearing was performed on an average nine days after surgery. The VAS scores immediately (3.16) and three months after surgery (2.63) were lower than that of the preoperative VAS score (8.3) (p<0.05). No cases of cement-leakage or neurologic symptoms were encountered. Two patients (6.7%) experienced a pulling-out of the screw, but bone-union was accomplished without any additional procedures.
CONCLUSION
Percutaneous iliosacral fixation with cement augmentation will be an appropriate and safe surgical option for osteoporotic sacral fractures in the elderly in terms of early weight-bearing, pain reduction, and bone-union.

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Decompressive Sacral Foraminotomy for Nerve Root Injury during Conservative Treatment of Sacral Fracture: A Case Report: Jung Gil Lee, Jae Hyuk Shin, Kwon Kim, Sang Min Choi, Moon Soo Park, Ho Guen Chang; J Korean Fract Soc 2017;30(1):24-28. Published online January 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.1.24

Abstract PDF: A 35-year-old woman visited the emergency department for a pedestrian traffic accident. Severe tenderness was noted at the posterior sacrum area, without open wound or initial neurologic deficit. Fracture of the left sacral ala extended to the S1 foramen, anterior acetabulum, and pubic ramus. Two weeks after the injury, she presented aggravating radiculopathy with the weakness of the left great toe plantar flexion. The S1 nerve root was compressed by the fracture fragments in the left S1 foramen. Decompressive S1 foraminotomy was performed. The postoperative follow-up computed tomography scan showed successful decompression of the encroachment, and the patient recovered well from the radiculopathy with motor weakness. She was able to resume her daily routine activity. We suggest that early decompressive sacral foraminotomy could be a useful additional procedure in selective sacral zone II fractures that are accompanied by radiculopathy with a motor deficit.

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Laminoplasty for Treatment of Transverse Sacral Fracture: A Case Report: Young Soo Jang, Jak Jang, Sung Ju Bae, Chan Il Bae, Sung Bae Park; J Korean Fract Soc 2014;27(2):157-161. Published online April 30, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.2.157

Abstract PDF: The transverse sacral fracture is rare; however, if it accompanies neurological injury or instability, difficult surgical treatment may be necessary. We performed surgical decompression and laminoplasty in a patient with neurological deficits and anterior displacement of S2 on S1. The patient showed a successful clinical outcome by neurological improvement.

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Usefulness of Kyphoplasty in Sacral Insufficiency Fracture: A Case Report: Soo Uk Chae, Yeung Jin Kim, Jung Hwan Yang, Ji Wan Lee; J Korean Fract Soc 2011;24(2):174-177. Published online April 30, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.2.174

Abstract PDF

Kyphoplasty has recently attended as a potential treatment for sacral insufficiency fracture. We report a 85-years-old female patient with osteoporotic S1 insufficiency fracture with absence of trauma history treated with kyphoplasty which has no symptom improve with conservative treatment. Kyphoplasty is an effective and useful procedure in the treatment of the sacral insufficiency fracture, additionally reviewed of the literatures.

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Pelvic Insufficiency Fracture in Severe Osteoporosis Patient
Woong Chae Na, Sang Hong Lee, Sung Jung, Hyun Woong Jang, Suenghwan Jo
Hip & Pelvis.2017; 29(2): 120. CrossRef

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Fracture-Dislocation of S1 in 3-Year-Old Boy: A Case Report: Sang Bong Ko, Sang Wook Lee; J Korean Fract Soc 2010;23(2):232-235. Published online April 30, 2010; DOI: https://doi.org/10.12671/jkfs.2010.23.2.232

Abstract PDF: Fracture-dislocation of the sacrum that has not yet fully developed is common in the distal sacrococcygeal joint of children, but this injury is rarely seen in 1st Sacrum. Most of these patients have a severe neurological deficit, so this injury generally requires surgical decompression. We managed a three year old patient who had a S1 fracture-dislocation without a neurological deficit, and the patient was treated with simple skin traction and bed rest without surgery. The child had a satisfactory result, so we report on this case with reviewing the relevant literatures.

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Upper Sacral Morphology Related to Iliosacral Screw Fixation in Korean: Jung Jae Kim, Chul Young Jung, Hyoung Keun Oh, Byoung Se Yang, Jae Suck Chang; J Korean Fract Soc 2007;20(2):115-122. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.115

Abstract PDF

PURPOSE
To evaluate upper sacral morphology and anatomy of safe zone related to iliosacral screw fixation in Korean.
MATERIALS AND METHODS
100 patients performed pelvis 3D CT scan were evaluated. We used 16 channel CT and analyzed reconstructed image (shaded-surface display, transparent image and reformat image).
RESULT
The angle between superior aspect of S1 body and iliac cortical density is 27.3Â°, between anterior cortical line of S1,2 body and horizontal plane 24.6Â°, and between superior aspect of S1 body and horizontal plane is 39.7Â°. The axis of S1, S2 pedicle is 32.5Â° and 15.6Â° toward anteromedial. The area of S1 pedicle according to sagittal plane and sagittal-oblique axis is 310.7 mm2 and 384.8 mm2. Also, S2 pedicle area is increased 163.1 mm2 to 188.4 mm2. The average depth of ala indentation is 5.1 mm and the maximal value is 9.5 mm. Distinct upper sacral dysplasia is 22%, transitional form is 32%.
CONCLUSION
We measured Korean upper sacrum with 3D-CT, found out dysplasia come up to 54%. Considering the frequency of dysplasia, the investigation of anatomy and technique is essential to sacroiliac screw insertion.

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Percutaneous posterior transiliac plate versus iliosacral screw fixation for posterior fixation of Tile C-type pelvic fractures: a retrospective comparative study
Chul-Ho Kim, Jung Jae Kim, Ji Wan Kim
BMC Musculoskeletal Disorders.2022;[Epub] CrossRef
Measurement of Optimal Insertion Angle for Iliosacral Screw Fixation Using Three-Dimensional Computed Tomography Scans
Jung-Jae Kim, Chul-Young Jung, Jonathan G. Eastman, Hyoung-Keun Oh
Clinics in Orthopedic Surgery.2016; 8(2): 133. CrossRef

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Radiologic Evaluation for the Safe Zone of Percutaneous Iliosacral Screw Fixation: Jong Keon Oh, Su Young Bae, Jong Oh Kim, Kwon Jae Roh, Jeong Joon Lee, Sang Yeol Chang; J Korean Soc Fract 2002;15(3):336-341. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.336

Abstract PDF

PURPOSE
To evaluate the correlation of the safe zone of percutaneous iliosacral screw fixation with sacral dysmorphism and sacral alar slope variation.
MATERIALS AND METHODS
We studied the plain radiographs and the pelvic bone CT images of 52 patients. We reviewed each cases in terms of Routt 's dysmorphism and sacral alar slope variation(anterior, coplanar and posterior to inter-ICD line). We divided each cases into narrow and wide groups by the width of safe zone for the transverse 6.5mm cannulated cancellous screw. The data were analysed by McNemar x2-test and Cochran Q-test(p<0.05).
RESULTS
Typical sacral dysmorphism was found in five cases(9%). Four cases with dysmorphism(80%) and eighteen non-dysmorphic cases(38.2%) revealed narrow safe zones. The sacral slopes were anterior in 16 cases, coplanar in 25 cases, and posterior in 11 cases. The safe zone was significantly narrow in the group with anterior slope variation.
CONCLUSION
We could not found definite correlation between sacral dysmorphism and a narrow safe zone because the incidence of dysmorphism was too low in our study which differed from Routt 's report. An anterior sacral alar slope on CT can be a significant risk indicator for potential narrow safe zone and the risk of screw malposition.

Citations

Citations to this article as recorded by

Measurement of Optimal Insertion Angle for Iliosacral Screw Fixation Using Three-Dimensional Computed Tomography Scans
Jung-Jae Kim, Chul-Young Jung, Jonathan G. Eastman, Hyoung-Keun Oh
Clinics in Orthopedic Surgery.2016; 8(2): 133. CrossRef
Operative Treatment of Unstable Pelvic Ring Injury
Sang Hong Lee, Sang Ho Ha, Young Kwan Lee, Sung Won Cho, Sang Soo Park
Journal of the Korean Fracture Society.2012; 25(4): 243. CrossRef
Upper Sacral Morphology Related to Iliosacral Screw Fixation in Korean
Jung-Jae Kim, Chul-Young Jung, Hyoung-Keun Oh, Byoung-Se Yang, Jae-Suck Chang
Journal of the Korean Fracture Society.2007; 20(2): 115. CrossRef

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Insufficiency Fracture of the Sacrum: Report of two cases: Young Kil Han, Young Su Jang; J Korean Soc Fract 2000;13(4):749-753. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.749

Abstract PDF: Insufficiency fractures of the sacrum are rare but a distinct subgroup of pathologic fractures characterized by reduced osseous elastic resistance due to structural alterations of the bone. Stress fractures occurring in the settings have been defined as insufficiency fractures. Insufficiency fracture of the sacrum are difficult to diagnose, as plain radiographic findings are either unhelpful or misleadining. Bone scan is very sensitive and shows moderate to high uptake but the characteristic of H-shaped pattern of increased uptake of sacroiliac joint, specific for an insufficiency fracture, is only rarely seen. M.R.I is clearly the examination of choice, as it reveals early medullary edema and frequently a fracture line in a typical location. M.R.I helps in distinguishing tumoral disease from an insufficiency fracture. In this report, two cases of insufficiency fracture of the sacrum are discribed and compared with those previous studies.

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The biomechanical Study on the Extraction Strengths of Iliosacral Lag Screws: Poong Taek Kim, Chang Wug Oh, Joo Chul Ihn, Jun Dae Kwun; J Korean Soc Fract 2000;13(4):696-701. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.696

Abstract PDF

PURPOSE
The purpose of this study is for the rigid fixation of the pelvic ring by quantifying and comparing the extraction strength of cancellous screws in the sacral ala and body.
MATERIALS AND METHODS
Six cadaveric human pelvis were obtained for test of the extraction strengths of three groups of 7.0mm cannulated cancellous screws: shortthreaded in the sacral ala, short-threaded in the sacral body, long-threaded in the sacral body. The extraction strengths of these groups were compared with each other.
RESULTS
The mean extraction strengths of short-threaded screws in the sacral ala, short-threaded screws in the sacral body and long-threaded screws in the sacral body were 10.26N, 25.85N and 48.37N respectively. The mean extraction strength of the long-threaded screws in the body was significantly greater than that of the shortthreaded screws in the ala and body. The mean extraction strength of the short-threaded screws in the body was greater than that of the short-threaded screws in the ala, but insignificant statistically.
CONCLUSION
In choosing iliosacral lag screws to stabilize the posterior pelvic ring disruption, superior fixation is achieved by inserting the long-threaded screw in the sacral body.

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Crescent Fracture-dislocation of Sacroiliac Joint: Affecting Factors of Operative Results
Hee-Soo Kim, Chang-Wug Oh, Poong-Taek Kim, Young-Soo Byun, Joo-Woo Kim, Byung-Chul Park, Woo-Kie Min, Hyun-Joo Lee
Journal of the Korean Fracture Society.2009; 22(2): 71. CrossRef

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