Effective Management of Sacral Stress Fractures in Gastric Cancer: Iliosacral Screw Fixation Following a Type 3 Hemipelvectomy

TL;DR

This case study shows how iliosacral screw fixation helped manage a rare sacral stress fracture in a gastric cancer patient after a hemipelvectomy.

Contribution

Highlights the effectiveness of iliosacral screw fixation for postoperative sacral stress fractures in metastatic pelvic tumor patients.

Findings

Iliosacral screw fixation significantly reduced pain and improved mobility in the patient.

Sacral stress fractures are a critical but often overlooked complication after hemipelvectomy.

Early intervention with surgical fixation enhances recovery and quality of life.

Abstract

Metastatic pelvic tumors pose a significant challenge in oncologic orthopedics due to their complex management and the high potential for postoperative complications. This case study discusses a 75-year-old male with a sacral stress fracture following a type 3 internal hemipelvectomy for a metastatic lesion from gastric cancer in the left pubic bone. Initial conservative treatments failed to yield satisfactory improvement, leading to surgical intervention. Open reduction and internal fixation with an iliosacral screw, despite complications, significantly alleviated pain and improved mobility. This case underscores the difficulty in diagnosing sacral stress fractures versus metastatic lesions and highlights the effectiveness of iliosacral screw fixation in managing postoperative sacral stress fractures. It emphasizes the procedure’s role in providing early pain relief and enhancing daily activity levels. Additionally, it points out the importance of addressing altered bone metabolism in the postoperative care of patients with metastatic pelvic tumors. This contributes to the literature by stressing the incidence of sacral stress fractures as a critical, though often overlooked, complication and demonstrating the benefits of iliosacral screw fixation in such scenarios for better recovery and quality of life.

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