Vertical Shear

Vertical shear

 

Definition

 

Unstable injuries

Complete disruption of both the anterior and posterior ring

 

5 - 20% of pelvic fractures

 

Mechanism

 

Axial load

Motor vehicle accident

Fall from height

 

Pathology

 

Anterior ring

- pubic symphysis disruption

- fracture of the superior and inferior pubic ramus

- fracture acetabulum

 

Posterior ring

- fracture sacrum / SI joint / ilium

 

Initial Management

 

Femoral steinman pin + 20lb weight to reduce vertical displacement

Anterior external fixation to pelvis

 

Vert shear inital management

 

 

Definitive Management

 

Verticla shearLumbosacral fixation

Lumbosacral fixation with SI screw - triangular osteosynthesis

 

Vert shear CTVertical shear fixation

 

Posterior stabilisation critical

 

Reduction

- closed

- open

 

Options

- sacro-iliac screws

- trans-sacral trans-iliac screws

- trans-iliac posterior tension band plating

- lumbosacral fixation

 

Anterior stabilisation

 

Pubic symphysis plates

Percutaneous ramus screws

 

Results

 

Griffin et al J Orthop Trauma 2006

- 62 patients with vertical shear fractures treated with SI screws

- increased failure rate in vertical sacral fractures compared sacro-iliac joint dislocation

 

Tisano et al OTA Int 2020

- 20 vertical shear fractures

- 12 sacro-iliac dislocations and 8 vertical sacral fractures

- no failures in sacro-iliac dislocations

- failure in 4/8 vertical sacral fractures

- 3/4 failures of vertical sacral fracture fixed with single SI screw