Open reduction of sacral fractures using transarticular implants at the articular facets of L7-S1: 8 consecutive canine patients (1995-1999)

OBJECTIVE: To describe and evaluate facet stabilization as an aid for open reduction and fixation of sacral fractures. STUDY DESIGN: A clinical case series. STUDY POPULATION: Eight consecutive client-owned dogs with sacral fractures. METHODS: A combination of a standard lateral approach to the ilium and a dorsal approach to the articular facets of L7-S1 was performed. The articular facets were reduced and stabilized with a Kirschner wire or a combination of a Kirschner wire and a cortical screw. Primary stabilization of the sacrum was then accomplished using a cortical screw inserted from the lateral aspect of the ilium, through the sacral fracture into the body of the sacrum. Accuracy of reduction, position of the implants, percent screw depth/sacral width, pelvic canal diameter ratio, and complications were assessed using radiographs and physical examination. RESULTS: Mean sacral fracture reduction was 91% immediately after surgery, and was 87% when measured at follow-up examinations. Mean screw depth/sacral width was 66%. Mean pelvic canal diameter ratio was 1.12 postoperatively and 1.03 at the 4- to 6-week reevaluation. Six of the 8 dogs were using the leg well 10 to 12 days after surgery; none had clinically detectable neurologic deficits. The long-term (mean, 2.7 years) outcome for these dogs was good (normal to grade I lameness). CONCLUSION: Fixation of the L7-S1 facet joints facilitates repair of sacral fractures.