Versorgung instabiler Verletzungen des hinteren Beckenringes – bewährte Methoden und neue Konzepte

[Closed reduction and minimally invasive fixation of a sacral avulsion fracture : Minimal invasiveness with maximum stability]

Surgical stabilization of high-energy sacral avulsion fractures with spinopelvic dissociation places high demands on the surgeon. The goal is to achieve maximum stability while minimizing invasiveness. The present case of a dislocated U‑type fracture in a 25-year-old motocross rider exemplifies how a reduction with the targeted application of closed reduction techniques through hyperextension of the hip joints and lordosis in the lumbosacral hinge and through a standardized procedure in intraoperative fluoroscopic imaging, a minimally invasive stabilization by means of transsacral screw fixation and spinopelvic fixation of lumbar vertebra 5 to the ilium in the sense of a bilateral triangular stabilization is possible without compromising the achieved stability of the osteosynthesis. The limitations of the described approach are also pointed out.