Using the Starr Frame and Da Vinci surgery system for pelvic fracture and sacral nerve injury

BACKGROUND: Sacral fracture and sacral nerve injury remain problems in orthopedics, especially in a sacral fracture combined with an anterior sacral nerve injury. Treating a sacral nerve injury with open reduction neurolysis or more conservative treatment cannot meet the clinical needs. Open reduction sacral nerve neurolysis will increase the number of severe, life-threatening injuries, regardless of whether the anterior or posterior approach is used. In recent years, computer- and robot-assisted orthopedic surgery has emerged as part of many clinical treatments. METHODS: For an unstable pelvic fracture with an anterior sacral nerve injury, we established a comprehensive and integrated solution. To achieve closed reduction, minimally invasive fixation, and minimally invasive anterior sacral nerve neurolysis, the Starr Frame, navigation robot, and Da Vinci robot were jointly applied. RESULTS: The Starr Frame is very helpful for closed reduction percutaneous fixation in complex pelvic fractures. In this study, a minimally invasive fixation technique for the navigation robot in the pelvic fracture was explored. Although the patient had delayed anterior sacral nerve compression pain after surgery, we developed an approach and surgical method using the Da Vinci robot to explore the sacral nerve by celiac decompression. The patient was relieved of nerve pressure and pain. CONCLUSIONS: This treatment method could be an alternative treatment for pelvic fractures and sacral nerve injury. The application of this treatment is a safe and feasible option that can be employed to manage early and late nerve repair with sacral fractures when open surgery or conservative treatment is unsuitable.