Mini-Open Stabilization of a Sacral Fracture: Technical Case Report

BACKGROUND AND IMPORTANCE: Comminuted sacral fractures present significant challenges for operative management. Open and percutaneous sacroiliac screws have been used for stabilization but carry not insignificant rates of complications, including wound infection for the former and malposition and neurological injury for the latter. We report the use of a novel mini-open lumbar-ilium fixation for stabilization of a patient with a comminuted sacral fracture. CLINICAL PRESENTATION: A 33-year-old man with intact neurologic function was admitted after a fall of approximately 25 ft. A comminuted sacral fracture was diagnosed. The patient was unable to tolerate conservative management because of pain in upright positions. The patient was taken to the operating room for stabilization with a "mini-open" procedure involving L4 and L5 pedicle screws and bilateral iliac screws. Four 2-in paramedian incisions were made overlying the L4-L5 facet joints and medial to the sacroiliac joints. Minimally invasive retractors were placed to expose bony landmarks. L4-L5 pedicle screws and bilateral iliac screws were placed with minimal fluoroscopic guidance. Titanium rods were tunneled inferior-superiorly between incisions and affixed to screw heads. Total operative time was approximately 3.5 hours. The patient remained neurologically intact and had an uncomplicated recovery. One-year follow-up computed tomography showed successful healing of the sacrum. CONCLUSION: We report the first case of a mini-open procedure to treat a comminuted sacral fracture. Use of this procedure offers a straightforward method for sacral stabilization with minimal blood loss and minimal radiation exposure. If indicated, this method could be combined with decompressive procedures.