PMC5835267_01
(a) Anteroposterior (AP) radiograph and (b) coronal CT cut demonstrating a comminuted Denis zone 2 sacral fracture with involvement of the sacral ala and fracture of the L4 and L5 transverse processes. (c, d) Axial CT cuts demonstrating the severe comminution involving the left sacral neuroforaminae.
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There were fractures also laterally at the sacral alae (Figures 1(a)-1(d)).
(a) AP fluoroscopic image after sacral reduction and provisional fixation with the spikes of the pelvic C-clamp embedded in the lateral ilium. (b) Clinical photograph of this patient with the pelvic C-clamp in place.
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Screw tightening is performed under fluoroscopic guidance to avoid over compression of the zone 2 sacral fracture (Figures 2(a) and 2(b)).
Intraoperative clinical photographs during definitive sacral ORIF. (a) Vertical zone 2 sacral fracture visible after irrigating and debriding the fracture site. Schantz pins attached to T-handle chucks placed in both posterior superior iliac spines are used as reduction tools. (b) Reduction of the sacral fracture maintained with a pelvic reduction forceps.
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Reduction was performed using a pelvic reduction forceps placed on the spinous process and lateral ilium, and Schanz pins placed in the posterior superior iliac spines (Figures 3(a) and 3(b)).
One-month (a) and one-year (b) postoperative AP radiographs.
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A reconstruction plate was added posteriorly as a tension band plate (Figure 4(a)). At one-year postop, the patient ambulates without assistive devices (Figure 4(b)).