Closed Reduction in a(Hyperextended Supine Position)with Percutaneous Transsacral-Transiliac and IliosacralScrew Fixation for Denis Zone III Sacral Fractures

Herein, we demonstrate the clinical results of closed reduction in a hyperextended supine position with transsacral-transiliac (TSTI) and iliosacral (IS) screw fixations for Denis zone III sacral fractures.Patients and Methods. Sixteen consecutivepatients with Denis zone III sacral fractures who were treated between January 2009 and September 2016 were evaluated. All patientswere treated using percutaneous TSTI/IS screw fixation during closed reduction performed with patients placed in a hyperextendedsupine position with body manipulation. The clinical and radiological results were evaluated, and the neurological outcomes wereretrospectively assessed using Gibbon’s classification system. The clinical outcomes were evaluated using the German MulticenterStudy Group Pelvic Outcome Scale (POS).Results. The sacral kyphotic angle was reduced by 18.06∘±15.26∘(mean kyphotic angle:pre-OP, 39.44∘±20.56∘;post-OP,21.38∘±7.39∘), and fracture translation was reduced by 5.93±4.95 mm (mean fracture translation:pre-OP, 8.69±8.03 mm; post-OP 2.75±3.97 mm). The mean initial Gibbon’s score was 3.00±1.32. Among 15 patients with afollow- pdurationofover12months,themeanreductionlossinthesacralkyphoticanglewas5.87∘±10.40∘and was 1.00±3.00mm for the fracture translation. The final Gibbon’s score was 1.80±1.21, and 73.3% of patients had good results based on the POSscore.Conclusions. Although closed reduction in a hyperextended supine position with percutaneous posterior screw fixation isassociated with some surgical limitations and technical difficulties, the procedure is minimally invasive and highly effective forstabilizing Denis zone III sacral fractures.