Sacral fractures: An updated and comprehensive review

Gutiérrez-Gómez, Santiago; Wahl, Lauren; Blecher, Ronen; Olewnik, Łukasz; Iwanaga, Joe; Maulucci, Christopher M.; Dumont, Aaron S.; Tubbs, R. Shane

doi:10.1016/j.injury.2020.11.015

Cited by 11 publications

(11 citation statements)

References 61 publications

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“…This risk is higher in Zone 2 and Zone 3 fractures. [2] We observed that S3-S4 involvement was proportionally more frequent in Zone 3 compared to Zone 2 fractures. This finding may guide surgeons to decide decompression levels.…”

Section: Discussionmentioning

confidence: 53%

Fracture lines and comminution zones of traumatic sacral fractures

Oğuzkaya

Güvercin

Kızkapan

et al. 2023

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Sacral fractures are uncommon and understanding three-dimensional morphology is needed to obtain proper treatment. The purpose of this study was to identify the repeatable fracture patterns and comminution zones for traumatic sacral fractures and create fracture maps. METHODS:Computerized tomography images of 72 patients with traumatic sacral fracture were included in the study. For each fracture, fracture lines were identified and digitally reduced. All fractures were superimposed over a template and fracture maps; comminution zones and heatmaps were created for each zone.RESULTS: There were 40 males and 32 females with a mean age of 46.5±19.9. Fifty-three (73.6%) patients sustained major trauma, and 19 (26.4%) had minor trauma. There were 37 (51.4%) Zone 1, 22 (30.6%) Zone 2, and 13 (18.1%) Zone 3 fractures. Each Denis zone showed certain fracture patterns. In Zone 1 fractures, most of the fracture lines were vertical and oblique (up to 45°) orientation on both sides. In Zone 2 fractures, fracture lines were concentrated on the S1 and S2 levels. Anterolateral and posterolateral parts of the sacrum were less affected in right-side fractures. In Zone 3 fractures, fractures were concentrated in S1, S2, and S3 levels around the sacral canal. The median sacral crest and midline remained mostly unaffected.CONCLUSION: Sacral fractures showed specific repeatable patterns for each zone. These findings may be helpful for pre-operative planning, placement of fixation material, design of new implants, and modification of current fracture-classification systems.

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Section: Discussionmentioning

confidence: 53%

Fracture lines and comminution zones of traumatic sacral fractures

Oğuzkaya

Güvercin

Kızkapan

et al. 2023

Ulus Travma Acil Cerrahi Derg

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“…SPD is caused by the axial vertical stress and shearing force of the spine relative to the bilateral ilium. The Table 4 The principle of classification guiding the treatment on the basis of force-displacement mechanism description of SPD classification in previous studies generally focused on the complex fractures of the sacrum [22][23][24][25][26], but did not include the conditions of transsacral injury on the one side and trans-sacroiliac joint injury on the other side of the conditions of trans-sacroiliac joint injuries on bilateral sides. Our results showed that out of the 30 patients, 7 were with transsacral injury on the one side and trans-sacroiliac joint injury on the other side, thus accounting for 23.3% of all included cases, while nine patients were with trans-sacroiliac joint injuries on bilateral sides, accounting for 30%.…”

Section: Discussionmentioning

confidence: 99%

Spinopelvic dissociation: extended definition, physical examination, classification, and therapy

Shi

Zhang

et al. 2023

J Orthop Surg Res

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Background Spinopelvic dissociation (SPD) is generally caused by high-energy injury mechanisms, and, in the absence of timely diagnosis and treatment, it can lead to chronic pain and progressive deformity. However, SPD is difficult to manage because of its rarity and complexity. In this study, we re-defined SPD according to the mechanism of injuries and biomechanical characteristics of the posterior pelvic ring and developed new classification criteria and treatment principles based on the classification for SPD. Methods Between June 2015 and September 2020, 30 patients with SPD which were selected from 138 patients with pelvic fractures were enrolled. Physical examination was performed, classification criteria (301 SPD classification) were developed, and specific treatment standards were established according to the classifications. Results The injury mechanisms and co-existing injuries did not significantly differ between the classical SPD patients and expanded SPD patients. The 301 SPD classification criteria covered all the patients. Fixation by biplanar penetration screws was used in 7 patients, 11 patients received fixation by uniplanar penetration screws, 6 patients used sacroiliac compression screws, 3 patients received uniplanar screws combined with sacroiliac compression screws, and open spondylopelvic fixation was used in only 3 patients. According to the Matta criteria, 19, 7, and 4 patients achieved excellent, good, and fair reduction. The Majeed function score of the patients ranged from 9 to 96 points, and the mean score was 72.9 ± 24.6 points. Conclusion The expanded definition for SPD is particularly significant for definite diagnosis and prevention of missing diagnosis, based on which the 301SPD classification criteria can more systemically guide the clinical treatment of SPD, increase the treatment efficacy, and reduce surgical trauma. Chinese Clinical Trial Registry: ChiCTR-IPR-16009340.

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“…41 Intriguingly, the literature often erroneously misquotes this seminal work by Isler as subclassifying fractures according to whether the fracture line passes lateral, through, or medial to the articular facet, despite the original classification being related specifically and exclusively only to fractures passing medial to the facet. 67,68 Fortunately, the AO system adheres to the initial intention of Isler by separating type B fractures as strictly those in which the S1 facet is continuous with the medial sacrum so that only posterior pelvic but not spinopelvic stability is affected. 46 It is unsurprising that an entire category should be dedicated to posterior injuries, given the greater associated mortality and associated injury compared with anterior fractures as established by Looser and Crombie.…”

Section: Discussionmentioning

confidence: 99%

Evolution of the AO Spine Sacral and Pelvic Classification System: a systematic review

Kweh

Tee

Öner

et al. 2022

Journal of Neurosurgery: Spine

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OBJECTIVE The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading systems. METHODS A systematic search of MEDLINE, EMBASE, Google Scholar, and Cochrane databases was performed consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all existing sacral and pelvic fracture classification systems. RESULTS A total of 49 articles were included in this review, comprising 23 pelvic classification systems and 17 sacral grading schemes. The AO Spine Sacral and Pelvic Classification System represents both the evolutionary product of these historical systems and a reinvention of classic concepts in 5 ways. First, the classification introduces fracture types in a graduated order of biomechanical stability while also taking into consideration the neurological status of patients. Second, the traditional belief that Denis central zone III fractures have the highest rate of neurological deficit is not supported because this subgroup often includes a broad spectrum of injuries ranging from a benign sagittally oriented undisplaced fracture to an unstable “U-type” fracture. Third, the 1990 Isler lumbosacral system is adopted in its original format to divide injuries based on their likelihood of affecting posterior pelvic or spinopelvic stability. Fourth, new discrete fracture subtypes are introduced and the importance of bilateral injuries is acknowledged. Last, this is the first integrated sacral and pelvic classification to date. CONCLUSIONS The AO Spine Sacral and Pelvic Classification is a universally applicable system that redefines and reorders historical fracture morphologies into a rational hierarchy. This is the first classification to simultaneously address the biomechanical stability of the posterior pelvic complex and spinopelvic stability, while also taking into consideration neurological status. Further high-quality controlled trials are required prior to the inclusion of this novel classification within a validated scoring system to guide the management of sacral and pelvic injuries.

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Sacral fractures: An updated and comprehensive review

Cited by 11 publications

References 61 publications

Fracture lines and comminution zones of traumatic sacral fractures

Fracture lines and comminution zones of traumatic sacral fractures

Spinopelvic dissociation: extended definition, physical examination, classification, and therapy

Evolution of the AO Spine Sacral and Pelvic Classification System: a systematic review

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