Closed Reduction in a “Hyperextended Supine Position” with Percutaneous Transsacral-Transiliac and Iliosacral Screw Fixation for Denis Zone III Sacral Fractures

Figure 5

Case 3. This case had the greatest loss of reduction. A 25-year-old woman who was injured from a fall from a height underwent unilateral S1 and S2 bilateral iliosacral partial threaded screw fixation for a Roy-Camille type 2 H-shaped transverse sacral fracture. (a) Preoperative 3-dimensional and sagittal plane CT reconstruction of the pelvis is shown (preoperative sacral kyphotic angle: 63°; fracture translation: 11 mm). (b) Postoperative anteroposterior radiograph and CT scan of the sacrum in the sagittal plane is shown (postoperative sacral kyphotic angle: 28°; fracture translation: 6 mm). (c) The anteroposterior radiograph and CT scan of the sacrum in the sagittal plane taken one month after the initial operative treatment is shown (sacral kyphotic angle: 60°; fracture translation: 14 mm). IS screw loosening was observed. Secondary sacral decompression was performed. (d) Final follow-up anteroposterior radiograph and CT scan of the sacrum in the sagittal plane is shown. Bone healing was achieved, but reduction loss and bladder/bowel dysfunction remained.