An Unusual Type of Fracture in the Upper Sacrum

Strange-Vognsen, Hans Henrik; Lebech, Anna

doi:10.1097/00005131-199105020-00014

Cited by 162 publications

(76 citation statements)

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“…Furthermore, the CT defined injury to the lumbar five (L5) transverse process and/ or L5-sacral 1 (S1) joint injury extension. Injuries were classified according to Tile [42], OTA/AO [19], Denis et al [2], Roy-Camille et al [28]/Strange-Vognsen and Lebech [39], and Isler [16] classification (Table 2).…”

Section: Methodsmentioning

confidence: 99%

“…In biomechanical testing, the triangular lumbopelvic fixation provides greater immediate postoperative stability than iliosacral screw fixation while unloading the area of injury [9,35] instead of compression [17]. This ability to perform in situ fixation without the necessity of a load-bearing second fragment makes it also a useful tool for spinopelvic dissociations [15] as a result of horizontal Roy-Camille and Strange-Vognsen type fractures [28,39,40]. However, because the fracture deformity often involves rotation of the upper sacrum [28], the use of a single screw may not provide adequate support against the deforming forces [15].…”

Section: Introductionmentioning

confidence: 99%

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Can Lumbopelvic Fixation Salvage Unstable Complex Sacral Fractures?

Jones

Sietsema

Hoffmann³

2012

Clinical Orthopaedics &Amp; Related Research

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Background Traditional screw or plate fixation options can be used to fix the majority of sacral fractures. However, these techniques are unreliable with dysmorphic upper sacral segments, U-fractures, osseous compression of neural elements, and previously failed fixation. Lumbopelvic fixation can potentially address these injuries but is a technically demanding procedure requiring spinal and pelvic fixation and it is unclear whether it reliably corrects the deformity and restores function.Questions/purposes We therefore assessed reduction quality and loss of fixation, pain related to prominent hardware, subjective dysfunction measured by the Short Musculoskeletal Function Assessment (SMFA), and complications. Methods We retrospectively reviewed 15 patients with unstable sacral fractures treated with lumbopelvic fixation between 2002 and 2010. Patients had radiographic monitoring regarding reduction quality and loss of fixation and clinical followup using the SMFA. The minimum followup was 12 months (mean, 23 months; range, 12-41 months).

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Can Lumbopelvic Fixation Salvage Unstable Complex Sacral Fractures?

Jones

Sietsema

Hoffmann³

2012

Clinical Orthopaedics &Amp; Related Research

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“…1 a Denis et al [2] classification shows the three zones of longitudinal sacral fractures. b Roy-Camille et al [3] classification shows the three types of combined longitudinal and transverse sacral fractures and the 4th type modified by Strange-Vognsen and Lebech [4] associated injuries. Full unaided weight bearing began 12.4 weeks on average (range 10-16 weeks) according to the evidence of good radiological healing.…”

Section: Postoperative Carementioning

confidence: 99%

“…Roy-Camille et al [3] described this injury but emphasized only the transverse sacral fracture (TSF), not the bilateral vertical elements. They identified three types, thereafter Strange-Vognsen and Lebech [4] (Fig. 1b) added a fourth type.…”

Section: Introductionmentioning

confidence: 98%

Displaced spinopelvic dissociation with sacral cauda equina syndrome: outcome of surgical decompression with a preliminary management algorithm

Ayoub

2012

Eur Spine J

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Introduction Displaced spinopelvic dissociation with cauda equina syndrome is still unclear challenging problem with multiple instabilities. This retrospective study tried to evaluate and analyze the results of surgical decompression and lumbopelvic fixation of these injuries. Methods Twenty-eight polytrauma patients with displaced spinopelvic dissociation and cauda equina syndrome were included. Preoperatively, they had thorough clinical, neurological, and radiological evaluation and classification. Operatively, they underwent primary, secondary, or tertiary decompression then spinopelvic fixation. Postoperatively, they were followed up for an average of 26 months. Hannover pelvic scoring system was applied for outcome evaluation. Results The mean age was 33.7 years; 17 cases were males and 11 were females. According to Roy-Camille, 13 cases had type II and 15 cases had type III injuries; cauda equina syndrome was incomplete in 17 cases and complete in 11 cases. Unilateral L5-S1 facet joint injury was detected in 13 cases; 14 cases had direct decompression (50 %) and 14 cases had indirect decompression (50 %). 19 patients (67.9 %) had excellent and good clinical outcome. Primary decompression had significantly increased the chances for neurological recovery (p = 0.024). Initial fracture kyphosis angles had a significant effect on neurological retrieval (p = 0.016). The mean of Gibbons score improved from 3.1 ± 0.83 preoperatively to 1.5 ± 0.84 at the end of follow-up with a highly significant impact (p = 0.001).Conclusions Surgical decompression and lumbopelvic segmental fixation can enhance neurological recovery and combat any structural instabilities associated with the displaced spinopelvic dissociation injuries with a hopeful clinical results.

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“…Although our case was occurred with the same injury mechanism we did not see ipsilateral rami fractures with the impacted sacral fracture. Only a few cases, related with the isolated sacral fracture, have been reported in the literature [1,3,6-8]. To our knowledge, no isolated vertical zone I fracture of the first sacral vertebra which occurred with the lateral compression injury has been described previously.…”

Section: Discussionmentioning

confidence: 98%

Isolated zone I vertical fracture of first sacral vertebra: a case report

et al. 2009

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Isolated sacral fractures which occur by shear forces on the pelvic ring are seen less commonly and they are commonly transversely oriented. A 29-year-old Turkish female patient, who sat in front seat in the car, was unrestrained, and another car hit them from right front side of their vehicle. Physical examination revealed considerable tenderness over the right superior gluteal region and excruciating pain during sacral and iliac compression. There was no clear fracture line in her plain radiographs. CT revealed incomplete, zone I fracture located on the superior and anterior part of the first sacral vertebra. Type 1 lateral compression pelvic fractures are relatively common and they include impacted sacral and ipsilateral rami fractures. Only a few cases, related with the isolated sacral fracture, have been reported in the literature. To our knowledge, no isolated vertical zone I fracture of the first sacral vertebra which occurred with the lateral compression injury has been described previously. Fracture of the sacrum should be suspected in the presence of sacral pain and tenderness.

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An Unusual Type of Fracture in the Upper Sacrum

Cited by 162 publications

References 0 publications

Can Lumbopelvic Fixation Salvage Unstable Complex Sacral Fractures?

Can Lumbopelvic Fixation Salvage Unstable Complex Sacral Fractures?

Displaced spinopelvic dissociation with sacral cauda equina syndrome: outcome of surgical decompression with a preliminary management algorithm

Isolated zone I vertical fracture of first sacral vertebra: a case report

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