27 World Spinal Column Journal, Volume 2 / No: 1 / January 2011 WScJ 2: 27-36, 2011 The Internal Fixator: A Novel Technique for Stabilization of Transforaminal Sacral Fractures as a Part of Pelvic Ring Disruption. A Preliminary Report Abdelfattah M.F. Saoud, M. Reda Abdelwahab Department of Orthopaedic and Spine Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt ABSTRACT Posterior injuries of the pelvic ring frequently occur as a result of transforaminal sacral fractures, and these lesions are probably the most difficult ones to reduce and stabilize. Currently applied procedures for management of these fractures do not provide (In our opinion) the optimum compromise between safety, easiness, minimization of operative time , intraoperative blood loss and postoperative complications and regaining all range of movement around the fractured sacropelvis. Therefore the authors developed a new technique that is characterized by being rapid, easy, safe, performed by minimally invasive technique and provides a reasonable stability almost without the need of fluoroscopy. It consists of one or two iliac screws connected by a transverse rod/rods and we are here giving this preliminary report about the new method. KEY WORDS: Minimally invasive spine surgery, Posterior pelvic ring stabilization, Sacral fractures, Transforaminal sacral fractures INTRODUCTION P osterior pelvic ring injuries occasionally involve the sacrum. Such sacral fractures are frequently displaced and unstable and sometimes associated with neurologic injuries (9,14). Reduction and stabilization of such fractures are difficult and carries risks of several iatrogenic complications (1,16,17). Posterior injuries of the pelvic ring frequently occur as transforaminal sacral fractures, and these lesions are probably the most difficult ones to reduce and stabilize (8). The surgical management consists of a wide spectrum of options from minimally invasive techniques to formal open reduction and internal fixation. Minimally invasive procedures can be carried out under CT or advanced three-dimensional imaging methods. Transiliac bars, posterior ilio-iliac plates, local plate fixation of sacral bone, iliosacral screws and spino-pelvic triangular fixation have been described (2-4, 11,13, 16- 18). and are reported to bring successful clinical results in various case series. In a comparative biomechanical study, Simonian et al. (15) in 1996 demonstrated that the various posterior techniques being frequently used in the treatment of transforaminal sacral fractures generated similar stability outcome. In the surgical management of a displaced sacral fracture, techniques allowing early mobilization as well as mechanical and neurological stability, are clearly an advantage.