# Fixation of unstable sacral fractures by transpedicular system: a prospective study

## TL;DR

This study evaluates the effectiveness of a transpedicular fixation system for treating unstable sacral fractures in adults, showing good functional and radiological outcomes.

## Contribution

The study introduces a transpedicular fixation system combined with a transverse element for unstable sacral fractures, demonstrating its efficacy in achieving satisfactory outcomes.

## Key findings

- The transpedicular fixation system significantly reduced postoperative displacement compared to preoperative measures.
- Neurological deficits improved significantly after treatment with the fixation system.
- The majority of patients (66.7%) achieved excellent or good functional outcomes based on the Majeed Score.

## Abstract

This study aimed to assess the functional and radiological outcome of transpedicular fixation system for managing unstable sacral fractures in adults.

This prospective case series study included 21 patients with unstable type C sacral fractures according to AO Spine classification of sacral fractures. The patients were treated by a transpedicular fixation system connecting the lower lumbar spine to the ilium, as a vertical element, which was bilateral in seven cases and unilateral in 14 cases. A transverse element connecting both sides of the posterior pelvic ring was added to augment fixation in the transverse plane. The minimum period of follow-up was 12 months.

Mean Majeed Score was 84,29 ± 9.97; excellent, good and fair classes were present in 14 (66.7%), five (23.8%) and two (9.5%) patients, respectively. There was a significant reduction of the vertical, anterior posterior and rotational displacement postoperatively in comparison to preoperative measures. There was a significant improvement in neurological deficit postoperatively. Eight (38.1%) patients developed complications postoperatively. Wound Infection was the most common complication.

The use of transpedicular fixation as a vertical element combined with a transverse element connecting both sides of the posterior pelvic ring, to treat unstable sacral fractures, offers adequate fixation strength that helps to achieve union in a well reduced position, leads to satisfactory functional outcome and improves neurological deficit.

(ID/NCT06888583) retrospectively registered.