From the Guidelines
The treatment for a sacral alar fracture typically involves surgical fixation with the goal of achieving anatomic reduction and stable fixation, as indicated by the presence of posterior pelvic ring instability, which represents a surgical indication for anatomic fracture reduction and stable internal fixation 1. The decision to operate is guided by the stability of the fracture and the patient's overall condition, with rotationally unstable and/or vertically unstable pelvic ring disruptions requiring surgical fixation, as seen in APC-II, LC-II, APC-III, LC-III, VS, and CM fracture patterns 1. Key considerations in the management of sacral alar fractures include:
- The technical modality of posterior pelvic ring fixation, which remains a topic of debate, with spinopelvic fixation offering the benefit of immediate weight bearing in patients with vertically unstable sacral fractures 1
- The use of adjunctive, temporary external fixation in selected lateral compression patterns with rotational instability, in conjunction with posterior pelvic ring fixation 1
- The importance of achieving anatomic reduction and stable fixation to allow early functional rehabilitation and decrease long-term morbidity, chronic pain, and complications associated with prolonged immobilization 1 In terms of specific treatment options, percutaneous iliosacral screw fixation or posterior tension band plating may be considered for unstable or significantly displaced fractures, with the goal of stabilizing the pelvic ring and allowing earlier mobilization 1. Regular follow-up imaging and monitoring for complications, including neurological deficits, deep vein thrombosis, and chronic pain syndromes, are also crucial in the management of sacral alar fractures.
From the Research
Treatment Options for Sacral Alar Fractures
The treatment for sacral alar fractures can vary depending on the severity and location of the fracture, as well as the presence of any neurological deficits.
- Conservative treatment is often used for stable fractures with no neurological deficits, and can result in satisfactory outcomes 2.
- Surgical management may be necessary for fractures with pelvic ring instability or neurological deficits, and can involve fracture reduction and stability reconstruction 2.
- Percutaneous ilio-sacral screw fixation is a minimally invasive technique that can be used to treat sacral fractures and sacro-iliac joint disruptions, and has been shown to be safe and effective 3, 4.
- Triangular osteosynthesis using an S1 pedicle screw and S2 alar iliac screw is a newer technique that has been proposed for the treatment of unilateral vertically displaced sacral fractures, and has the advantage of maintaining mobility in the lumbar pelvic region and reducing soft tissue damage 5.
Considerations for Treatment
When treating sacral alar fractures, it is important to consider the following factors:
- The presence of neurological deficits, which can affect treatment outcomes 2, 4.
- The stability of the pelvic ring, which can impact the choice of treatment 2, 6.
- The location and severity of the fracture, which can influence the choice of surgical technique 3, 4, 5.
- The potential risks and complications of treatment, such as screw malpositioning or neurovascular injury 3, 4.
Outcomes and Complications
The outcomes of treatment for sacral alar fractures can vary depending on the severity of the fracture and the effectiveness of treatment.
- Good to excellent outcomes have been reported for percutaneous ilio-sacral screw fixation 3.
- Complications such as screw malpositioning, neurovascular injury, and infection can occur, but are relatively rare 3, 4.
- The risk of fixation failure is higher for vertical sacral fractures than for dislocations or fracture-dislocations of the sacro-iliac joint 6.