Articles: triangular-osteosynthesis.
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Iliosacral screw osteosynthesis is a widely recognized technique for stabilizing unstable posterior pelvic ring injuries, offering notable advantages, including enhanced mechanical stability, minimal invasiveness, reduced blood loss, and lower infection rates. However, the procedure presents technical challenges due to the complex anatomy of the sacrum and the proximity of critical neurovascular structures. ⋯ Particular attention must be given to the preoperative evaluation of both the iliosacral and transsacral corridors, as anatomical variations may restrict the available space for screw insertion. This review aims to highlight the essential aspects of sacroiliac osteosynthesis, with a focus on the critical role of thorough preoperative planning and its impact on achieving successful surgical outcomes.
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Spinopelvic dissociation (SPD) is a severe injury characterized by a discontinuity between the spine and the bony pelvis consisting of a bilateral longitudinal sacral fracture, most of the times through sacral neuroforamen, and a horizontal fracture, usually through the S1 or S2 body. The introduction of the concept of triangular osteosynthesis has shown to be an advance in the stability of spinopelvic fixation (SPF). However, a controversy exists as to whether the spinal fixation should reach up to L4 and, if so, it should be combined with transiliac-transsacral screws (TTS). ⋯ According to our results, it can be concluded that in SPD, better stability is obtained when proximal fixation is only up to L5, without including L4 (alternative hypothesis), the addition of transiliac-transsacral fixations is essential.
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Eur J Trauma Emerg Surg · Apr 2022
Role of triangular osteosynthesis in vertically unstable transforaminal sacrum fractures: clinical and radiological outcomes.
We aim to report clinical and radiological results of triangular osteosynthesis for a homogenous group of vertically unstable transforaminal sacral fractures. ⋯ Triangular osteosynthesis is a reliable procedure in treating unstable transforaminal sacral fractures. It permits early weight-bearing and facilitates faster functional recovery. Careful attention to details such as sacral dysmorphism, soft tissue injury, implant placement and anterior pelvic injury helps in keeping complications to an acceptable rate.
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Spinopelvic dissociation (SPD) is difficult to manage and is associated with high mortality and morbidity, including concomitant orthopaedic polytrauma, spine injuries, pelvic ring disruptions, neurological, soft-tissue, and vascular injuries. The purpose of this study is to evaluate the functional and radiological outcomes; health related quality of life and complication rates of patients with traumatic spinopelvic dissociation underwent bilateral triangular osteosynthesis (TOS). ⋯ Bilateral TOS demonstrates satisfactory functional and radiological outcomes with low complication rates except infection rate in patients with traumatic spinopelvic dissociation. HRQoL is mainly dominated by pain and mood disorders. 78.9% of the patients turned back to their original occupation. Surgeons should be aware of wound healing problems in case of increased muscle mobilization and degloving injuries.Implant removal is required to improve the lumbopelvic mobility.
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Managing unilateral vertically displaced sacral fractures remains a challenge. A triangular osteosynthesis (TOS), which involves fixing the fractured sacrum using unilateral spinopelvic fixation and a supplemental ilio-sacral screw, continues to gain popularity as it facilitates early mobilization and improves the long-term outcome. However, it has limitations, such as destruction of the L5-S1 joint, the need for additional removal surgery, and an increased risk of infection due to the large incision. An S1 pediculoiliac construct was proposed to overcome this limitations. Its use also has complications, however, including a painful hardware prominence due to the traditional iliac screw, excessive soft tissue retraction, and limited reduction capability. ⋯ For unilateral vertically unstable sacral fractures, TOS using S1 pedicle screws and S2AIS is safe and has the advantage such as maintaining mobility in the lumbar pelvic region, small size wounds, and reduced soft tissue damage, and it may have a potentially low infection rate. Further studies are needed to determine the specific indications and validate the effectiveness of this procedure.