CT of Sacral Fractures: Classification Systems and Management

Dreizin, David; Smith, Elana B.

doi:10.1148/rg.220075

Cited by 8 publications

(7 citation statements)

References 52 publications

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“…Although sacral fractures are among the most common fractures in spine scans performed at the ER [3] , a CSF leak following a sacral fracture is rare and often attributed to the shifting of displaced fracture fragments causing a tear in the dura mater.…”

Section: Discussionmentioning

confidence: 99%

Unsuspected cerebrospinal fluid leak following a minor sacral fracture: A case report

Filho,

Dwan,

Edelmuth

et al. 2024

Radiology Case Reports

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Section: Discussionmentioning

confidence: 99%

Unsuspected cerebrospinal fluid leak following a minor sacral fracture: A case report

Filho,

Dwan,

Edelmuth

et al. 2024

Radiology Case Reports

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“…The primary mechanism of these fractures is vertical loading, leading to horizontal fractures in the sacrum [ 15 ]. The classification proposed by Roy-Camille, which focuses on vertical instability and is based on flexion and displacement, has been widely accepted for evaluating these injuries [ 16 ]. These fractures are generally unstable and often involve neurological impairment.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Lumbosacral Fixation in Patients with Suicidal Jumper\'s Fractures: A Retrospective Study from a Single Center in Turkey

Atiç,

Alemdar,

Ulus

et al. 2023

Med Sci Monit

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Background Suicide attempts that involve jumping from a great height may not be fatal but can result in lumbosacral facture-dislocations. This retrospective study aimed to present the experience from a single center in Turkey of 21 patients with lumbosacral facture-dislocations, or suicidal jumper fractures, treated with lumbosacral fixation between 2015 and 2022. Material/Methods The study included 21 patients. The diagnosis was established through X-ray and computed tomography (CT) examinations. Neurological damage was assessed using the Gibbons score. Among the patients, 2 were classified as Roy-Camille type 1, 12 as Roy-Camille type 2, and 7 as Roy-Camille type 3. Morphologically, 8 patients had H-type fractures, 7 had T-type fractures, and 6 had U-type fractures. Bilateral spinopelvic fixation was performed. Functional outcomes were evaluated using the Majeed score. Results The average Injury Severity Score (ISS) was 31.6±12.2. The mean duration of surgery was 123.6±44.9 minutes. According to the Majeed score, excellent results were observed in 8 individuals (40%), good results in 5 individuals (25%), fair results in 5 individuals (25%), and poor results in 2 individuals (10%). Out of 18 patients with neurological deficits, 14 showed improvement after surgery, while 4 continued to experience deficits. Conclusions The findings from this study highlight the importance of obtaining a clear history of the cause of lumbosacral facture-dislocation, as attempted suicide by jumping from a height can cause specific types of injury to the lumbar spine and sacrum that require rapid diagnosis and management to reduce the incidence of permanent paraplegia.

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“…U-type fractures are commonly associated with some degree of neurological compromise due to the complex regional anatomy that can impinge upon or transect the nerve roots emerging from the cauda equina through the sacral foramina [10]. The gold standard diagnostic technique for sacral fractures is a CT scan; longitudinal and U-type fractures are generally best appreciated on sagittal and coronal reconstruction [11].…”

Section: Discussionmentioning

confidence: 99%

“…In the setting of suspected neural compromise, a magnetic resonance imaging (MRI) scan can further distinguish cauda equina or nerve root involvement [11]. The treatment of these fractures varies depending on the type of fracture, degree of fracture displacement, pelvic instability, and presence of neurological symptoms such as radiculopathy and/or sphincter dysfunction [12].…”

Section: Discussionmentioning

confidence: 99%

A Case of U-shaped Sacral Fracture After Longstanding Spinopelvic Fixation Treated With Percutaneous Sacroiliac Joint Fusion and Iliosacral Osteosynthesis

Ganeshan,

Denis

2023

Cureus

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Sacral fractures are pelvic ring injuries that usually occur following a fall from height and may present with neurological injury. They are divided into several subtypes based on the pattern and location of injury. Certain subtypes require operative management due to the risk of neural compromise and inadequate axial load transfer, limiting mobility. Spinopelvic fixation has been reported as an efficient surgical treatment to restore the stability of U-shaped sacral fractures and to accelerate healing by relieving sacral stress. It is unclear if low-velocity sacral fractures occurring after longstanding lumbosacral fusion with pelvic fixation require additional surgical intervention. An elderly female with osteoporosis and prior T4-pelvis instrumented fusion sustained a fragility sacral fracture and was treated conservatively. At follow-up, she developed a symptomatic U-shaped sacral fracture. The increased fracture displacement and nonunion were chiefly attributed to sacroiliac joint hypermobility. A percutaneous osteosynthesis at the S1 and S2 levels was performed with a novel type of implant to achieve concomitant sacroiliac joint stabilization and fusion. Implants were placed with the help of intraoperative three-dimensional imaging and image-guided navigation to avoid the previously installed pelvic hardware. In summary, U-shaped fractures can develop nonunion despite pre-existing spinopelvic fixation and can be treated adequately with percutaneous iliosacral osteosynthesis. A sacroiliac joint fixation and fusion should be considered in the same setting as sacroiliac joint instability may contribute to or exacerbate nonunion.

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CT of Sacral Fractures: Classification Systems and Management

Cited by 8 publications

References 52 publications

Unsuspected cerebrospinal fluid leak following a minor sacral fracture: A case report

Unsuspected cerebrospinal fluid leak following a minor sacral fracture: A case report

Outcomes of Lumbosacral Fixation in Patients with Suicidal Jumper\'s Fractures: A Retrospective Study from a Single Center in Turkey

A Case of U-shaped Sacral Fracture After Longstanding Spinopelvic Fixation Treated With Percutaneous Sacroiliac Joint Fusion and Iliosacral Osteosynthesis

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