Kurzfassung

Due to aging of our population the number of fatigue fractures of the pelvic ring is quickly growing. These fractures are often treated with bed rest but may result in a disabling immobility with severe pain. An operative treatment should be perfomed in these cases. The aim of operative treatment is bony healing obtained by stable fixation giving back to the patient his previous mobility. Optimal surgical treatment is still under debate. Most commonly sacroiliac screws are used. Only low...Due to aging of our population the number of fatigue fractures of the pelvic ring is quickly growing. These fractures are often treated with bed rest but may result in a disabling immobility with severe pain. An operative treatment should be perfomed in these cases. The aim of operative treatment is bony healing obtained by stable fixation giving back to the patient his previous mobility. Optimal surgical treatment is still under debate. Most commonly sacroiliac screws are used. Only low compression in the fracture site is obtained due to low density of spongious bone in which the screws are inserted. Therefore the new trans-sacral bar compression osteosynthesis is used. The purpose of this study is to report of our first cases.
From 2005 to 2010 11 patients (9 F and 2 M) were treated with a trans-sacral bar osteosynthesis and followed prospectively. The patient is placed in prone position on the operation table. Under image intensifier control, a 5mm threaded sacral bar is inserted through the body of S1 from the left to the right dorsal ilium. Nuts are placed over the bar achieving fracture compression. When anterior pelvic instability is present, an anterior osteosynthesis is also performed.
The follow-up examination included a clinical and radiological investigation as well as the SF 36 score.
The mean age of the patients was 73 years at time of operation. The mean follow-up was 14 months. Postoperatively there was a temporary nerve palsy of L5 in one case. 8 patients showed a major improvement in the clinical outcome. In 10 cases there was a bony healing.
Trans-sacral bar osteosynthesis for stabilization of the dorsal pelvic ring in fatigue fractures is a promising method. 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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