الفهرس 
ACKNOWLEDGEMENTOnly 14 pages are availabe for public view
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Abstract
Vertically unstable posterior ring injury of the pelvis are a result of high energy trauma and may lead to significant functional morbidity if treated inefficiently. Reduction and stable fixation of sacral fracture component of Type C injuries are difficult and no consensus is available for optimal surgical techniques. Tension band effect of a stable posterior pelvic ring can be restored by trans-sacral tension band plating.
The aim of this study is to evaluate the outcome of minimal invasive tension band plating of sacrum in vertically unstable posterior ring injuries of the pelvis with sacral fracture; Tile Type-C.
from March 2013 to August 2014, 17 patients with sacral fractures were treated by Posterior Tension Band Plate in a prospective consecutive series. They were operated upon at the Trauma Unit and Department of Orthopaedic, Assiut University Hospitals.
“17” patients were included in this study, 12 (70.6%) were males and 4 (29.4%) were females.
The age of the patients ranged from 17 to 62 years and the mean age was 33.0+12.2 years. The majority of the patients were between 20-39 years (75.0%).
The Unilateral sacral fractures was in 15 (88.2%) patients, and bilateral fracture occurred in 2 (11.8%) patients.
16 patients was Dennis type II sacral fractures(94.1%), and one patient Dennis type III(5.9%).
According to Tile’s classification there were 9 patients Tile type C1-3 (52.9%), 7 patients Tile type C2 (41.2%)and one patient Tile type C3(5.9%).
The mechanism of injury was a motor vehicle accident in “10” patients (58.8%), fall from hight in ”6”patients (35.3%) and fall of heavy object on the patient in “1” (5.9%) .
In the study there were two multi-injured patients with Injury Severity Score (ISS) was 32 and 25 .
The indication of fixation by Posterior tension band plate in a 16 cases was comminuted sacral fracture and in one case for bilateral sacral fracture.
Pre operative planning done to all patients by measuring the iliac inclination at the point about 2 cm below the tip of PSIS to preoperative bending of the plate.
The aim of measuring this angle is to make the plate fit on the posterior aspect of the pelvic and to control the function of the plate either tension band mechanism or bridging plate.
General anaesthesia was the role in our series. Fixation were done under general anaesthesia in “14” procedures , while “3” procedures were done under spinal anaesthesia.
The patient positioned prone on radiolucent table and bilateral oblique incision done just lateral to PSIS a limited portion of the gluteus maximus is reflected off the erector spinae fascia. prebent 4.5 mm narrow DCP plate(ORTHOMED®) 12hole is used. The position of the dorsal tension band plate is just below the PSIS.In our series the total radiation time ranged from 3 to 7 seconds with mean fluoroscopy time 4.7+1.4 seconds.The operative time ranges frome 15 to 60 minutes with the average time 40+9.2 minutes.
According toMatta and Tornetta grading system we assesed the reduction immediate post operative and after 6 months of fixation.
The difference between the two measurements are statistically insignificant .
There were 9 patients (52.9%)excellent , 6 patents(35.3%)were good and two (11.8%) patents were poor reduction.
According to function majeed outcome scoring system , we found that ,There were 11 patients was working before surgery with 10 patients (90.9%) were excellent function outcome, one patient (9.1%) was good and no cases of fair or poor reduction.
The rest of the patients (6 patients), 4 (66%)patients were excellent, one patient (16.7 %) was good and one patient (16.7 %) was fair with no poor function outcome.