Critical review of the classification and treatment of pediatric pelvic fractures.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declaration of Competing Interest The authors have no competing interests. 3. Orthop Traumatol Surg Res. 2016 Feb;102(1 Suppl):S45-57. doi: 10.1016/j.otsr.2015.12.002. Epub 2016 Jan 22. Osteosynthesis in sacral fracture and lumbosacral dislocation. Pascal-Moussellard H(1), Hirsch C(2), Bonaccorsi R(3). Author information: (1)Service d'orthopédie, CHU Pitié-Salpêtrière, pavillon Gaston-Cordier, 7(e) étage, 47-83, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: hmoussellard@yahoo.fr. (2)Service d'orthopédie, CHU Pitié-Salpêtrière, pavillon Gaston-Cordier, 7(e) étage, 47-83, boulevard de l'Hôpital, 75013 Paris, France. (3)Service d'orthopédie, CHU Pitié-Salpêtrière, pavillon Gaston-Cordier, 7(e) étage, 47-83, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: drraphaelbonaccorsi@hotmail.fr. Sacral fracture and lumbosacral hinge trauma are rare but serious lesions. Neurologic disorder is frequently associated, and nerve release may be required, with reduction and stabilization of the fracture. Management requires knowing the fracture lines and reduction maneuvers and the fixation techniques that may need to be associated. Three classifications allow these fractures to be well understood: the Roy-Camille classification identifies high transverse fractures and their displacement; the Denis classification identifies vertical fracture line location within the sacrum, which correlates with neurologic risk; and the Tile classification analyzes pelvic ring trauma when associated with the sacral fracture. Treatment, when surgical, requires careful patient positioning, sometimes on an orthopedic table. Reduction maneuvers are founded on the fracture classification. Isolated U-shaped fracture of the sacrum is to be distinguished from sacral fracture associated with pelvic ring lesion. Osteosynthesis may be lumbopelvic or restricted to the pelvic ring (sacroiliac or iliosacral). Open osteosynthesis allows reduction to be finalized by intraoperative maneuvers on the implant, while closed osteosynthesis requires perfect preoperative reduction. Complications are frequent and neurologic recovery is uncertain. Fatigue and osteoporotic fractures show little displacement and are good indications for cementoplasty, either isolated or associated to iliosacral screwing. In lumbosacral hinge trauma, and dislocation in particular, reduction surgery with fixation (usually 360°) is indicated. The present study details the analysis and classification of these fractures, the technical pitfalls of reduction and fixation, and treatment indications. Copyright © 2015 Elsevier Masson SAS. All rights reserved. DOI: 10.1016/j.otsr.2015.12.002