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F2.1 Finite element analysis of the stability of transverse acetabular fractures in standing and sitting positions by different fixation options
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Osteosynthese International 2013 – Friday, 15 February / Injury, Int. J. Care Injured 44S2 (2013) S7–S13
F1.4 Verification of the reliability of the Radiographic Union Score for Tibial Fractures in the follow-up of patients with tibia corpus fractures operated via the intramedullary nailing technique using the patients’ clinical condition E. Çekic1 , E. Alici2 . 1Kutahya Tavsanli State Hospital, 2Dokuz Eylul University, Izmir, Turkey
F1.6 Treatment of tibia distal diaphyso-metaphyseal fractures with new design MBDLS (Monobloc Distal Locking Screw) interlocking nail 2 , F. Akpinar3 . ¨ ukdurmaz ¨ N. Saglam1 , T. Kurtulmus1 , G. Saka1 , F. Kuc 1Ümraniye Training and Research Hospital, 2Bezmi Alem University, 3Abant Izzet Baysal University, Istanbul, Turkey
Introduction: The aim of this study was to clinically verify the hypothesis of ‘Radiographic Union Score for Tibial Fractures (RUST)’ introduced in 2010. Materials and Methods: Forty-one patients with tibia corpus fractures that had undergone intramedullary nailing at the Dokuz Eylul ¨ University Medical Faculty Orthopedics and Traumatology Department between 2005 and 2010, were included in the study. The Karlstrom-Olerud physical function scale evaluation was performed dduring the follow-up examinations. VAS at rest and during activity, and SF-36 physical function and pain scores were obtained according to this scale. Results: The patients were then radiographically evaluated and scored according to the RUST scoring system. The data were then compared to each other. As a result, the Radiographic Union Score for Tibial Fractures scoring system was found to be significant in terms of the p value when compared to the physical functions and pain scores of the patients. In other terms, when the union findings of the patients were physically good, the RUST scores were generally high. Furthermore, there was significance in the comparisons of other parameters with each other. Conclusion: In the light of this information, the Radiographic Union Score for Tibial Fractures scoring system may be used in the future subsequent to wider studies, or at least it may be used as a source for further scoring systems
Introduction: In the treatment of tibial distal fractures with nail, reduction and rigid fixation are still the most important problems to be solved. In our study, the clinical and radiological result of treated with unreamed tibia nail locking with a single screw in distal and healing was achieved except one in all patients. Materials and Methods: The data of forty-seven patients were (28 male, 19 female; mean age: 49 years; range 16 to 81years) recorded and prospectively followed. Forty patients were closed and 8 were open fractures. The fractures were AO/OTA seventeen 42-A1 in patients, six 42-A2 in, ten 42-B1 in, nine 42-B2 in, two 42-C3 in, one 43-A1 in, one 43-A3 in, one 43-B1 in, one 43-B2 in. We allowed early full weight bearing all patients. The patients were assessed clinically and radiographically within a mean follow-up period of 33 months (range 14 to 52). Results were evaluated according to criteria of Johner and Wrush. Results: Union was achieved except one in all patients within a mean of 4.4 months (range 3 to 6 months). Six patients had limitation of ankle movements in a range of 5 to 15 degrees. Distal screw loosening, migration, breakage and loss of reduction were not observed. We found two superficial infection, one nonunion, one delayed union, six procurvatum in a range of 5 to 10 degrees and one patient shorthening of limp as complications. Conclusions: The newly design MBDLS (monobloc distal locking screw) interlocking tibia nail to reduce the complications related to distal screws. Provides rigid fixation and sustainable mechanical stability with a single locking screw in distal tibia has advantages such as allowing the patients early and full mobility, independence with daily activities while speeding up healing.
F1.5 Iatrogenic pes valgus following successful surgical treatment of cruris diaphyseal fracture ¨ ul ¨ 2 , A. Kara3 , M. Adas4 , B. Beksac5 , V.E. Özden1 . M. Uzun1 , A.M. Bulb 1Acibadem Maslak Hospital, 2Medipol University, 3Sisli Etfal Training and Research Hospital, 4Okmeydani Training and Research Hospital, 5Acibadem University, Istanbul, Turkey Introduction: Tibial diaphyseal fractures are generally treated surgically and often accompany fibular fractures. If a concomitant fibular fracture is in the mid-proximal third, it is treated symptomatically. Materials and Methods: This study aimed to answer these two questions: in surgically treated tibial shaft fractures, does conservative treatment of concomitant supra-syndesmotic fractures lead to ankle deformity? if deformity develops, does this affect ankle functional results? The study comprised a random selection of 30 patients who had been treated with anatomic reduction iM nailing for a tibial mid-third fracture, with conservative treatment for a concomitant fibular proximal-mid third fracture (suprasyndesmotic). The alignment of the back of the foot was evaluated in the manner described by Saltzman, together with the fibula and tibia lengths and compared with the other extremity. Functional results were evaluated according to the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Foot and Ankle Disabilty index Score (FADi). Results: Anatomic union was determined of the tibia and of the same length compared to the other extremity. A mean shortness of 1.2 cm (0–2 cm) was determined in the fibula. On the radiographs of 21 of 30 patients, an increase in valgus was determined compared to the other extremity. Conclusion: It is thought to be necessary to have anatomic stabilisation of the fibula to prevent the development of pes valgus, which may develop because of shortness in supra-syndesmotic fibular fractures concomitant to bifocal fractures.
10.30–11.10 F2. Acetabular and Pelvic Fractures Chairmen: P Giannoudis, P Rommens, M Arazi, H Kınık F2.1 Finite element analysis of the stability of transverse acetabular fractures in standing and sitting positions by different fixation options 3 , Ö.F. Öken1 , A.Ö. Yildirim1 , K.B. Alemdaroglu2 , H.Y. Yuksel ¨ A. Ucaner1 . 1Ankara Numune Education and Research Hospital Orthopaedic and Traumatology Clinic, 2Ankara Education and Research Hospital Orthopaedic and Traumatology Clinic, 3Ankara Acibadem Hospital Orthopaedic and Traumatology, Ankara, Turkey Introduction: Treatment of a transverse acetabular fracture type is possible from an anterior approach, posterior approach or both. However, it is controversial that which approach should better let the surgeon stabilize a transverse fracture, as reduction can often be managed from any of these approaches. Both of these approaches permit adequate plate and screw fixation, and supplementary opposite colon fixation. Materials and Methods: Investigation was done by utilizing threedimension finite element stress analysis by using isotropic materials and static linear analysis. Transtectal transverse fracture model was fixed in five different alternatives: an anterior column plate; a posterior column plate; an anterior column plate combined with posterior column screw; a posterior column plate combined with anterior column screw; and double plate. In these models, a load of 400N was applied at standing and sitting positions and the displacements were analyzed.
Osteosynthese International 2013 – Friday, 15 February / Injury, Int. J. Care Injured 44S2 (2013) S7–S13
Results: In the model simulates standing, overall motion at the posterior column was minimum when two columns were plated (0.071 mm). The second best fixation was posterior column plate with anterior column screw (0.077 mm). Overall motion at the anterior column was minimum by posterior column plate with an anterior column screw (0.0326 mm). The successor was plating two columns (0.0333 mm). In the model that simulates sitting, overall at posterior column motion was minimum when two columns were plated (0.047 mm), and then posterior column plate with an anterior column screw (0.051 mm). Overall motion in the anterior column was minimum when posterior column plate with an anterior column screw (0.019 mm) two columns were plated (0.047 mm), and then plating both columns (0.0203 mm). Conclusion: Posterior column plating combined with anterior column screw has quite comparable results to both column plating in transverse fractures, making two column fixation unnecessary. This method is also very superior to anterior column plating combined with a posterior column screw in that type of fractures. F2.2 Male sexual dysfunction after pelvic fracture C. Çopuroglu1 , B. Yilmaz2 , S. Yilmaz2 , M. Özcan1 , M. Çiftdemir1 , E. Çopuroglu1 . 1Trakya University, 2Adiyaman Besni DH, Adiyaman, Turkey Introduction: Pelvic fractures usually result from high-energy trauma. Sexual dysfunction is a significant complication after pelvic fracture. Though anatomical problems can be a reason of sexual disorders, psychological factors following a trauma may also be linked to sexual problems. Materials and Methods: To evaluate the frequency of sexual dysfunction after pelvic and acetabular fractures, and to help pelvic fracture patients with their usually undisclosed sexual problems, through timely referrals to relevant clinics, and offer them support. We retrospectively evaluated a 2-year period, which included 18 male patients with a mean age of 41.8-years (range, 19–61 years), based on our institutional data. All patients were requested to complete the Arizona Sexual Experience Scale (ASEX), which is a 5-item self-evaluation scale. According to the results of the questionnaire, patients who needed supportive treatment were referred to the psychiatry department. Results: Nine patients (50%) scored 10 points or less in the ASEX questionnaire. The remaining 9 patients (50%) had 11 points or more. Two (22.2%) of these 9 patients had a score of 19 points or more. Patients with a score of 19 points, any one item with a score of 5 or 6 points, or any three or more items with a score of 4 points were considered to have a high probability of sexual dysfunction through psychiatric examination. High probability patients were considered as patients with a definite need for psychiatric treatment. Conclusion: The frequency of sexual dysfunction in pelvic fracture patients was tested, and the necessity of orthopedic surgeons need for investigating early history of pelvic fractures in patients with sexual disorders was stressed. This study will attract the attention of orthopedic surgeons to sexual dysfunction in patients with pelvis fractures and the necessity of referring them to related clinics for treatment. F2.3 Epidemiology of pelvic and acetabular fractures in a Ümraniye-Istanbul T. Kurtulmus1 , N. Saglam1 , G. Saka1 , M. Abughalwa1 , C. Avci1 . 1Ümraniye Training and Research Hospital, Istanbul, Turkey Introduction: Pelvic and acetabular fractures are usually caused by high-energy trauma such as traffic accident, fall from height, crush injuries, and may have associated other organ systems damage. These fractures occur in all ages.
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Materials and Methods: We evaluated all the cases of pelvic and acetabular fractures that conservative and underwent surgery over a six year period (from 2006 to 2012) was carried out, retrospectively. Population of Ümraniye city is approximately 800.000 and ten private hospital, one training and research hospital are in Ümraniye. We classified this fracture according to modified Tile AO Muller ¨ classification. We recorded demographic data, injury mechanism and site of injury. Results: We hospitalized 64 acetabular and 139 pelvic fractures, totally 203 patients. We operated 11 pelvic fractures of 139 patients (Group A), 17 acetabular fractures of 64 patients (Group B). Mean age was 49 (13–86) years in group A, 42 (797) years in group B. The etiology of fractures was 73 traffic accident, 23 fall from height, 12 suicide attempt, 10 crush, 19 fall of ground level, 2 sport activities in group A and 37 traffic accident, 12 fall from height, 8 suicide attempt, 6 fall from stairs, 1 gunshot in group B. We recorded accompanying complication with fractures. Conclusion: We found in our study that all age groups were affected by this injury and traffic accident and fall from height occurred in young men and children, simple traumas in elderly patients and suicide in young lady. We operated 29 patients (13.8%) with releated unstable pelvic and acetabular fractures. F2.4 Is posterior tension band plating for vertically unstable transforaminal sacral fractures safe in terms of soft tissues? H. Kinik1 , T. Ahmad2 . 1Ankara University, Dept of Orthopedics & Traumatology, 2Acibadem Ankara Hospital, Dept of Orthopedics & Traumatology, Ankara, Turkey Introduction: In the management of vertically unstable sacral fractures, fixation techniques including transiliac bars, iliosacral screws and reconstruction plates were advocated. Transiliac bars have lower biomechanical properties. Iliosacral screws were shown a high failure rate in transforaminal fractures. Posterior tension band plating was considered as disadvantageous in terms of wound complications. The purpose of this study was to evaluate the complication rate and short-term outcome of vertically unstable transforaminal sacral fractures treated by posterior tension band plate fixation. Materials and Methods: All patients were treated by the same surgeon between years 2005–2010 with a posterior approach using 4.5 mm reconstruction plates and various forms of internal or external anterior pelvic ring fixation. The group had 25 patients (11 male and 14 female) with a mean age of 34.6 years whom were followed for at least 12 months by the same surgeon. The mean follow-up was 18.76 months. One very large soft tissue contusion, 1 subcutaneous laceration and 1 large dermabrasion were identified in three patients. Results: Ten patients had various associated skeletal injuries. Mean surgical incision length was 13.36 cm in the fractured side. Mean healing time of fracture is 7.84 weeks. There was one deep infection in the series that necessitates multiple debridement, irrigation and antibiotic cement bead applications. In one patient with associated transverse acetabular fracture and symphyseal diastasis; Pfannenstiel, triradiate Y and also posterior pelvic approaches were used for fixation. This patient had a local posterior wound necrosis and superficial infection that was treated with debridement and a rotational flap that healed uneventfully. All the fractures united without any implant failure or loss of reduction. Conclusion: Posterior plate fixation of vertically unstable transforaminal sacral fractures is stable enough to prevent loss of reduction, necessitates little radiation exposure and safe in terms of wound problems.
Osteosynthese International 2013 – Friday, 15 February / Injury, Int. J. Care Injured 44S2 (2013) S7–S13
F1.4 Verification of the reliability of the Radiographic Union Score for Tibial Fractures in the follow-up of patients with tibia corpus fractures operated via the intramedullary nailing technique using the patients’ clinical condition E. Çekic1 , E. Alici2 . 1Kutahya Tavsanli State Hospital, 2Dokuz Eylul University, Izmir, Turkey
F1.6 Treatment of tibia distal diaphyso-metaphyseal fractures with new design MBDLS (Monobloc Distal Locking Screw) interlocking nail 2 , F. Akpinar3 . ¨ ukdurmaz ¨ N. Saglam1 , T. Kurtulmus1 , G. Saka1 , F. Kuc 1Ümraniye Training and Research Hospital, 2Bezmi Alem University, 3Abant Izzet Baysal University, Istanbul, Turkey
Introduction: The aim of this study was to clinically verify the hypothesis of ‘Radiographic Union Score for Tibial Fractures (RUST)’ introduced in 2010. Materials and Methods: Forty-one patients with tibia corpus fractures that had undergone intramedullary nailing at the Dokuz Eylul ¨ University Medical Faculty Orthopedics and Traumatology Department between 2005 and 2010, were included in the study. The Karlstrom-Olerud physical function scale evaluation was performed dduring the follow-up examinations. VAS at rest and during activity, and SF-36 physical function and pain scores were obtained according to this scale. Results: The patients were then radiographically evaluated and scored according to the RUST scoring system. The data were then compared to each other. As a result, the Radiographic Union Score for Tibial Fractures scoring system was found to be significant in terms of the p value when compared to the physical functions and pain scores of the patients. In other terms, when the union findings of the patients were physically good, the RUST scores were generally high. Furthermore, there was significance in the comparisons of other parameters with each other. Conclusion: In the light of this information, the Radiographic Union Score for Tibial Fractures scoring system may be used in the future subsequent to wider studies, or at least it may be used as a source for further scoring systems
Introduction: In the treatment of tibial distal fractures with nail, reduction and rigid fixation are still the most important problems to be solved. In our study, the clinical and radiological result of treated with unreamed tibia nail locking with a single screw in distal and healing was achieved except one in all patients. Materials and Methods: The data of forty-seven patients were (28 male, 19 female; mean age: 49 years; range 16 to 81years) recorded and prospectively followed. Forty patients were closed and 8 were open fractures. The fractures were AO/OTA seventeen 42-A1 in patients, six 42-A2 in, ten 42-B1 in, nine 42-B2 in, two 42-C3 in, one 43-A1 in, one 43-A3 in, one 43-B1 in, one 43-B2 in. We allowed early full weight bearing all patients. The patients were assessed clinically and radiographically within a mean follow-up period of 33 months (range 14 to 52). Results were evaluated according to criteria of Johner and Wrush. Results: Union was achieved except one in all patients within a mean of 4.4 months (range 3 to 6 months). Six patients had limitation of ankle movements in a range of 5 to 15 degrees. Distal screw loosening, migration, breakage and loss of reduction were not observed. We found two superficial infection, one nonunion, one delayed union, six procurvatum in a range of 5 to 10 degrees and one patient shorthening of limp as complications. Conclusions: The newly design MBDLS (monobloc distal locking screw) interlocking tibia nail to reduce the complications related to distal screws. Provides rigid fixation and sustainable mechanical stability with a single locking screw in distal tibia has advantages such as allowing the patients early and full mobility, independence with daily activities while speeding up healing.
F1.5 Iatrogenic pes valgus following successful surgical treatment of cruris diaphyseal fracture ¨ ul ¨ 2 , A. Kara3 , M. Adas4 , B. Beksac5 , V.E. Özden1 . M. Uzun1 , A.M. Bulb 1Acibadem Maslak Hospital, 2Medipol University, 3Sisli Etfal Training and Research Hospital, 4Okmeydani Training and Research Hospital, 5Acibadem University, Istanbul, Turkey Introduction: Tibial diaphyseal fractures are generally treated surgically and often accompany fibular fractures. If a concomitant fibular fracture is in the mid-proximal third, it is treated symptomatically. Materials and Methods: This study aimed to answer these two questions: in surgically treated tibial shaft fractures, does conservative treatment of concomitant supra-syndesmotic fractures lead to ankle deformity? if deformity develops, does this affect ankle functional results? The study comprised a random selection of 30 patients who had been treated with anatomic reduction iM nailing for a tibial mid-third fracture, with conservative treatment for a concomitant fibular proximal-mid third fracture (suprasyndesmotic). The alignment of the back of the foot was evaluated in the manner described by Saltzman, together with the fibula and tibia lengths and compared with the other extremity. Functional results were evaluated according to the Knee injury and Osteoarthritis Outcome Score (KOOS) and the Foot and Ankle Disabilty index Score (FADi). Results: Anatomic union was determined of the tibia and of the same length compared to the other extremity. A mean shortness of 1.2 cm (0–2 cm) was determined in the fibula. On the radiographs of 21 of 30 patients, an increase in valgus was determined compared to the other extremity. Conclusion: It is thought to be necessary to have anatomic stabilisation of the fibula to prevent the development of pes valgus, which may develop because of shortness in supra-syndesmotic fibular fractures concomitant to bifocal fractures.
10.30–11.10 F2. Acetabular and Pelvic Fractures Chairmen: P Giannoudis, P Rommens, M Arazi, H Kınık F2.1 Finite element analysis of the stability of transverse acetabular fractures in standing and sitting positions by different fixation options 3 , Ö.F. Öken1 , A.Ö. Yildirim1 , K.B. Alemdaroglu2 , H.Y. Yuksel ¨ A. Ucaner1 . 1Ankara Numune Education and Research Hospital Orthopaedic and Traumatology Clinic, 2Ankara Education and Research Hospital Orthopaedic and Traumatology Clinic, 3Ankara Acibadem Hospital Orthopaedic and Traumatology, Ankara, Turkey Introduction: Treatment of a transverse acetabular fracture type is possible from an anterior approach, posterior approach or both. However, it is controversial that which approach should better let the surgeon stabilize a transverse fracture, as reduction can often be managed from any of these approaches. Both of these approaches permit adequate plate and screw fixation, and supplementary opposite colon fixation. Materials and Methods: Investigation was done by utilizing threedimension finite element stress analysis by using isotropic materials and static linear analysis. Transtectal transverse fracture model was fixed in five different alternatives: an anterior column plate; a posterior column plate; an anterior column plate combined with posterior column screw; a posterior column plate combined with anterior column screw; and double plate. In these models, a load of 400N was applied at standing and sitting positions and the displacements were analyzed.
Osteosynthese International 2013 – Friday, 15 February / Injury, Int. J. Care Injured 44S2 (2013) S7–S13
Results: In the model simulates standing, overall motion at the posterior column was minimum when two columns were plated (0.071 mm). The second best fixation was posterior column plate with anterior column screw (0.077 mm). Overall motion at the anterior column was minimum by posterior column plate with an anterior column screw (0.0326 mm). The successor was plating two columns (0.0333 mm). In the model that simulates sitting, overall at posterior column motion was minimum when two columns were plated (0.047 mm), and then posterior column plate with an anterior column screw (0.051 mm). Overall motion in the anterior column was minimum when posterior column plate with an anterior column screw (0.019 mm) two columns were plated (0.047 mm), and then plating both columns (0.0203 mm). Conclusion: Posterior column plating combined with anterior column screw has quite comparable results to both column plating in transverse fractures, making two column fixation unnecessary. This method is also very superior to anterior column plating combined with a posterior column screw in that type of fractures. F2.2 Male sexual dysfunction after pelvic fracture C. Çopuroglu1 , B. Yilmaz2 , S. Yilmaz2 , M. Özcan1 , M. Çiftdemir1 , E. Çopuroglu1 . 1Trakya University, 2Adiyaman Besni DH, Adiyaman, Turkey Introduction: Pelvic fractures usually result from high-energy trauma. Sexual dysfunction is a significant complication after pelvic fracture. Though anatomical problems can be a reason of sexual disorders, psychological factors following a trauma may also be linked to sexual problems. Materials and Methods: To evaluate the frequency of sexual dysfunction after pelvic and acetabular fractures, and to help pelvic fracture patients with their usually undisclosed sexual problems, through timely referrals to relevant clinics, and offer them support. We retrospectively evaluated a 2-year period, which included 18 male patients with a mean age of 41.8-years (range, 19–61 years), based on our institutional data. All patients were requested to complete the Arizona Sexual Experience Scale (ASEX), which is a 5-item self-evaluation scale. According to the results of the questionnaire, patients who needed supportive treatment were referred to the psychiatry department. Results: Nine patients (50%) scored 10 points or less in the ASEX questionnaire. The remaining 9 patients (50%) had 11 points or more. Two (22.2%) of these 9 patients had a score of 19 points or more. Patients with a score of 19 points, any one item with a score of 5 or 6 points, or any three or more items with a score of 4 points were considered to have a high probability of sexual dysfunction through psychiatric examination. High probability patients were considered as patients with a definite need for psychiatric treatment. Conclusion: The frequency of sexual dysfunction in pelvic fracture patients was tested, and the necessity of orthopedic surgeons need for investigating early history of pelvic fractures in patients with sexual disorders was stressed. This study will attract the attention of orthopedic surgeons to sexual dysfunction in patients with pelvis fractures and the necessity of referring them to related clinics for treatment. F2.3 Epidemiology of pelvic and acetabular fractures in a Ümraniye-Istanbul T. Kurtulmus1 , N. Saglam1 , G. Saka1 , M. Abughalwa1 , C. Avci1 . 1Ümraniye Training and Research Hospital, Istanbul, Turkey Introduction: Pelvic and acetabular fractures are usually caused by high-energy trauma such as traffic accident, fall from height, crush injuries, and may have associated other organ systems damage. These fractures occur in all ages.
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Materials and Methods: We evaluated all the cases of pelvic and acetabular fractures that conservative and underwent surgery over a six year period (from 2006 to 2012) was carried out, retrospectively. Population of Ümraniye city is approximately 800.000 and ten private hospital, one training and research hospital are in Ümraniye. We classified this fracture according to modified Tile AO Muller ¨ classification. We recorded demographic data, injury mechanism and site of injury. Results: We hospitalized 64 acetabular and 139 pelvic fractures, totally 203 patients. We operated 11 pelvic fractures of 139 patients (Group A), 17 acetabular fractures of 64 patients (Group B). Mean age was 49 (13–86) years in group A, 42 (797) years in group B. The etiology of fractures was 73 traffic accident, 23 fall from height, 12 suicide attempt, 10 crush, 19 fall of ground level, 2 sport activities in group A and 37 traffic accident, 12 fall from height, 8 suicide attempt, 6 fall from stairs, 1 gunshot in group B. We recorded accompanying complication with fractures. Conclusion: We found in our study that all age groups were affected by this injury and traffic accident and fall from height occurred in young men and children, simple traumas in elderly patients and suicide in young lady. We operated 29 patients (13.8%) with releated unstable pelvic and acetabular fractures. F2.4 Is posterior tension band plating for vertically unstable transforaminal sacral fractures safe in terms of soft tissues? H. Kinik1 , T. Ahmad2 . 1Ankara University, Dept of Orthopedics & Traumatology, 2Acibadem Ankara Hospital, Dept of Orthopedics & Traumatology, Ankara, Turkey Introduction: In the management of vertically unstable sacral fractures, fixation techniques including transiliac bars, iliosacral screws and reconstruction plates were advocated. Transiliac bars have lower biomechanical properties. Iliosacral screws were shown a high failure rate in transforaminal fractures. Posterior tension band plating was considered as disadvantageous in terms of wound complications. The purpose of this study was to evaluate the complication rate and short-term outcome of vertically unstable transforaminal sacral fractures treated by posterior tension band plate fixation. Materials and Methods: All patients were treated by the same surgeon between years 2005–2010 with a posterior approach using 4.5 mm reconstruction plates and various forms of internal or external anterior pelvic ring fixation. The group had 25 patients (11 male and 14 female) with a mean age of 34.6 years whom were followed for at least 12 months by the same surgeon. The mean follow-up was 18.76 months. One very large soft tissue contusion, 1 subcutaneous laceration and 1 large dermabrasion were identified in three patients. Results: Ten patients had various associated skeletal injuries. Mean surgical incision length was 13.36 cm in the fractured side. Mean healing time of fracture is 7.84 weeks. There was one deep infection in the series that necessitates multiple debridement, irrigation and antibiotic cement bead applications. In one patient with associated transverse acetabular fracture and symphyseal diastasis; Pfannenstiel, triradiate Y and also posterior pelvic approaches were used for fixation. This patient had a local posterior wound necrosis and superficial infection that was treated with debridement and a rotational flap that healed uneventfully. All the fractures united without any implant failure or loss of reduction. Conclusion: Posterior plate fixation of vertically unstable transforaminal sacral fractures is stable enough to prevent loss of reduction, necessitates little radiation exposure and safe in terms of wound problems.