Injury
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Due to ageing of our population the number of fatigue fractures of the pelvic ring is steadily growing. These fractures are often treated with bed rest but may result in a disabling immobility with severe pain. An operative treatment is an option in these cases. The aim of operative treatment is bony healing obtained by stable fixation giving back to the patient's previous mobility. Optimal surgical treatment is currently under debate. Sacroiliac screw fixation and sacroplasty are used for stabilization of the dorsal pelvis. Due to the technique and the low density of spongious sacral bone, no or only low compression in the fracture site is obtained, which may inhibit bony healing. The trans-sacral bar compression osteosynthesis is presented as an alternative procedure. We present the outcome of 11 patients, who were treated with this method. ⋯ Trans-sacral bar osteosynthesis is a promising method for stabilization of fatigue fractures of the pelvic ring. Only with this method, a high interfragmentary compression is achieved, independent of the quality of the spongious bone of the sacral body.
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Randomized Controlled Trial
The application of a computer-assisted thermoplastic membrane navigation system in screw fixation of the sacroiliac joint--a clinical study.
We inserted iliosacral screws with the aid of a computer-assisted thermoplastic membrane navigation (CATMN) system which is widely used for the accurate and repeatable location tumour in radiation therapy. We hypothesised that application of the CATMN system on IS screws' insertion will provide a superior result to conventional fluoroscopic imaging with less operative time, more accuracy and lower complication rates. ⋯ Application of CATMN system has high accuracy in treating sacroiliac joint dislocations and provides a new alternative method for guidance of the IS screw placement.
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Traumatic spinopelvic dissociation is a rare high-energy injury pattern, characterised by a transverse sacral fracture in conjunction with bilateral sacral fracture-dislocations. It has a high incidence of neurological complications. The true nature of the injury is easily missed and diagnosis is delayed because it commonly presents in patients with severe associated injuries. ⋯ There is no single treatment paradigm and various surgical strategies have been described in the literature. Lumbopelvic fixation or triangular osteosynthesis has recently been recommended by several authors to restore stability at the lumbosacral junction. This article presents a review of the incidence, clinical evaluation, treatment methods and outcomes of this injury pattern.