Surgical outcome of lumbopelvic fixation in cases of sacral fractures

Abstract

Background

Sacral fractures are uncommon but potentially devastating injuries, accounting for approximately 1–5% of all spinal fractures. Unstable Denis Zone II and III sacral fractures frequently require operative stabilization to restore spinopelvic continuity, allow early mobilization, and prevent progressive deformity or delayed neurological deterioration. Lumbopelvic fixation (
LPF
) has emerged as a biomechanically superior stabilization technique for these unstable fractures.



Purpose

This prospective-retrospective observational cohort study aims to evaluate the clinical, neurological, radiological, and functional outcomes of
LPF
in patients with unstable Denis Zone II and III sacral fractures.



Methods

Twenty-nine patients with traumatic sacral fractures underwent
LPF
. All patients underwent standardized preoperative evaluation including neurological examination using the American Spinal Injury Association (ASIA) impairment scale, pain assessment using the Visual Analog Scale (VAS), and radiological evaluation with CT and MRI. Patients were followed at 3 and 6 months postoperatively. Primary outcome measures included neurological recovery, pain reduction, and radiological stability.



Results

The mean age was 31.9 ± 10.2 years; 69.0% were male (20/29) and 31.0% female (9/29). By Denis classification, Zone II accounted for 65.5% (19/29), Zone III for 27.6% (8/29), and Zone I for 6.9% (2/29). Of 17 patients presenting with neurological deficits (ASIA B–D), 12 demonstrated at least one ASIA grade improvement at 6-month follow-up
.
Mean operative time was 173.9 ± 15.1 min and estimated blood loss was 299.0 ± 29.3 ml. At 6 months, the mean VAS improved from 5.4 ± 0.6 to 1.2 ± 0.6 (
p
 < 0.001, Cohen’s d = 4.69,
95% CI: 3.73–4.61
). Radiographic outcomes were uniformly favorable with 100% fracture union. All patients returned to activity with no recorded complications and no revision surgeries through 6 months.



Conclusion
Lumbopelvic fixation for unstable sacral fractures demonstrated satisfactory pain reduction, universal fracture union, and no recorded complications within the 6-month follow-up period. These preliminary findings support further investigation in larger prospective cohorts with longer follow-up.