[Ortho] Sacral Non-Union

[Maxim Agalakov]

Remove IS screwes, then  perform weight-bearing x-rays standing on one leg.
In case of instability, drilling of the zone of sacral nonunion and another screw fixation may lead to fracture consolidation and pain relief. 

Late hardware failure usually is asymptomatic but nonunion of the anterior column may sometimes simulate low back pain. In this situation just wait and give NSAIDS.


Huegli RW, Messmer P, Jacob AL, Regazzoni P, Styger S, Gross T.
Delayed union of a sacral fracture: percutaneous navigated autologous cancellous bone grafting and screw fixation. : Cardiovasc Intervent Radiol. 2003 Sep-Oct;26(5):502-5.

Delayed or non-union of a sacral fracture is a serious clinical condition that may include chronic pain, sitting discomfort, gait disturbances, neurological problems, and inability to work. It is also a difficult reconstruction problem. 
Late correction of the deformity is technically more demanding than the primary treatment of acute pelvic injuries. Open reduction, internal fixation (ORIF), excision of scar tissue, and bone grafting
often in a multi-step approach are considered to be the treatment of choice in delayed unions of the pelvic ring. This procedure implies the risk of neurological and vascular injuries, infection, repeated failure of union, incomplete correction of the deformity, and incomplete pain relief as the most important complications. The lesion was successfully treated percutaneously in a single step procedure using CT navigation for drilling of the delayed union, autologous bone grafting, and screw fixation.
Maxim Agalakov