Sacral Fractures and Spinopelvic

Background 

• 25% associated neuro 
  • 33-100% of SPD have neupp 
• Transvese pattern 

Classification Denis 

• Zone 1 – lateral to foramen 
  • Most common 
  • 5% neve – if so, L5 
• Zone 2 – through 
  • Sstable or unstable 
    • Shear is unstable 
• Zone 3 – medial 
  • High rate neuro 
• Transverse 
• U Type 
  • Spinopelvic 

Gibbon’s for Neuro (SPD) 

1 – none 

2 – parrassthesia 

3 – LE motor 

4 – bowel bladderr 

Imaging 

• Inlet view best X 
• CT best imaging 
• MRI if nuro 

Sacral Dysmorphism 

• Residual disc 
• Mamillary body 
• Misshapen sacral foramen 
• Tongue in groove 
• Sacral ala acute slope 
• S1 not reecessed (it is high) 

Management 

• Non op 
• Operative 
  • Decompression 
  • Reduction 
    • For 
      • Kyphotic deformity 
        • Kyphosis leads to fatiguability with walking 
    • Method 
      • Direct or indirect 
    • Parameters 
      • LL and PI within 10 
  • Fixation (SPD) 
    • Isolated TITS – low energy eldery 
    • Triangular osteosynthesis is ideal 
    • Spinal and iliac fixation +/- sacral fix 
      • Ie: sacral dysmorphissm or fractur epreventing TITS 
      • Lumbar fixation to Iliac Screws 
        • L4 if no TITS 
      • Do the sacral/ pelvic fixation first 
      • Iliac Screw (reverse AIIS ex fix pin): OOO, I, OI “OOO I have OI” 
        • Tipi view (Obturator Outlet Oblique) – out of the acetab  
        • Iliac – keeps you above sciatic notch 
        • Obturator Inlet – keeps you within the tables