Management of complex pelvic fracture and sacral fracture Denis type 2 using spanning unilateral fixation of L5 to S2AI screw

Introduction. Posterior sacropelvic ring injury due to vertical shear type sacral fracture is the result of high-energy trauma. This fracture may be accompanied by neurological injury in 50% of cases. An understanding of sacral anatomy, its mechanisms of injury and types of sacral fracture, as well as treatment options may change the rational of the approach. The unique anatomic shape in the sacropelvic junction and the complex biomechanical forces can present challenges when attempting anterior and posterior pelvic reconstruction and instrumentation.
Presentation of case. In this case, we present a complex pelvic fracture and sacral fracture Denis type 2 managed with staged operations consisting of anterior reconstruction followed by posterior reconstruction using spanning unilateral fixation of 5th lumbar to 2th Sacral-Alar-Iliac with different incision technique from the normal conventional approach. Discussion. The use of 2th sacral Alar iliac screws (S2AI screw) offered immediate stability and helped in fracture reduction while creating good biomechanical strength, there was no need for cross-connectors which minimized the prominence of the implant, and also decreased the risk of post-operative wound infection. Conclusion. The new technique of spinopelvic fixation provides increased immediate postoperative stability. Success of this procedure can be achieved by performing the procedures systematically on appropriately selected patients.