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Delayed Union of a Sacral Fracture: Percutaneous Navigated Autologous Cancellous Bone Grafting and Screw Fixation

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Abstract

Delayed or non-union of a sacral fracture is a serious clinical condition that may include chronic pain, sitting discomfort, gait disturbances, neurological problems, and inability to work. It is also a difficult reconstruction problem. Late correction of the deformity is technically more demanding than the primary treatment of acute pelvic injuries. Open reduction, internal fixation (ORIF), excision of scar tissue, and bone grafting often in a multi-step approach are considered to be the treatment of choice in delayed unions of the pelvic ring. This procedure implies the risk of neurological and vascular injuries, infection, repeated failure of union, incomplete correction of the deformity, and incomplete pain relief as the most important complications. We report a new approach for minimally invasive treatment of a delayed union of the sacrum without vertical displacement. A patient who suffered a Malgaigne fracture (Tile C1.3) was initially treated with closed reduction and percutaneous screw fixation (CRPF) of the posterior pelvic ring under CT navigation and plating of the anterior pelvic ring. Three months after surgery he presented with increasing hip pain caused by a delayed union of the sacral fracture. The lesion was successfully treated percutaneously in a single step procedure using CT navigation for drilling of the delayed union, autologous bone grafting, and screw fixation.

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Acknowledgements

This work was partially funded by the Swiss National Science Foundation through the National Center of Competence in Research (Co-Me) http://co-me.chhttp://co-me.ch

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Authors and Affiliations

  1. Department of Radiology, University Hospital, Basel, Switzerland

    R. W. Huegli & S. Styger

  2. Division of Trauma Surgery, University Hospital, Zürich, Switzerland

    P. Messmer

  3. Department of Surgery, Trauma Unit, University Hospital, Basel, Switzerland

    A. L. Jacob, P. Regazzoni & T. Gross

Authors
  1. R. W. Huegli
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  2. P. Messmer
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  3. A. L. Jacob
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  4. P. Regazzoni
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  5. S. Styger
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  6. T. Gross
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Correspondence to R. W. Huegli.

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Huegli, R., Messmer, P., Jacob, A. et al. Delayed Union of a Sacral Fracture: Percutaneous Navigated Autologous Cancellous Bone Grafting and Screw Fixation . CVIR 26, 502–505 (2003). https://doi.org/10.1007/s00270-003-0071-4

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