Minimally invasive fixation of a sacral bilateral fracture with lumbopelvic dissociation

This case report describes our technique of percutaneous sacroiliac screw fixation of a bilateral sacral fracture with spinopelvic dissociation. It is based on the description of an iliosacroiliac bony corridor delimited by the following landmarks: the sacral ala in a superior-anterior direction, the first sacral foramen on both sides in an inferior-posterior direction, and the sacral channel posteriorly. The described operating method, which uses a 6.5-mm parallel drill sleeve, allows the safe and strictly transversal positioning of a 7.3-mm screw on each side with the threads interlocking. It provides a separate and fracture-adapted compression of the screws. The interlocking SI screw threads increase the pull-out strength. Operating time and radiation dose can be reduced significantly by this method.