The Importance of Sagittal 2D Reconstruction in Pelvic and Sacral Trauma: Avoiding Oversight of U-Shaped Fractures of the Sacrum

Levy

et al. 2021

Spine

Study Design. Cross-sectional survey. Objective. To determine the influence of surgeons' level of experience and subspeciality training on the reliability, reproducibility, and accuracy of sacral fracture classification using the Arbeitsgemeinschaft fu ¨r Osteosynthesefragen Spine Sacral Classification System. Summary of Background Data. A surgeons' level of experience or subspecialty may have a significant effect on the reliability and accuracy of sacral classification given various levels of comfort with imaging assessment required for accurate diagnosis and classification. Methods. High-resolution computerized tomography (CT) images from 26 cases were assessed on two separate occasions by 172 investigators representing a diverse array of surgical subspecialities (general orthopedics, neurosurgery, orthopedic spine, orthopedic trauma) and experience (<5, 5-10, 11-20, >20 yrs). Reliability and reproducibility were calculated with Cohen kappa coefficient (k) and gold standard classification agreement was determined for each fracture morphology and subtype and stratified by experience and subspeciality. Results. Respondents achieved an overall k ¼ 0.87 for morphology and k ¼ 0.77 for subtype classification, representing excellent and substantial intraobserver reproducibility, respectively. Respondents from all four practice experience groups demonstrated excellent interobserver reliability when classifying overall morphology (k ¼ 0.842/0.850, Assessment 1/Assessment 2) and substantial interobserver reliability in overall subtype (k ¼ 0.719/ 0.751) in both assessments. General orthopedists, neurosurgeons, and orthopedic spine surgeons exhibited excellent interobserver reliability in overall morphology classification and substantial interobserver reliability in overall subtype classification. Surgeons in each experience category and subspecialty correctly classified fracture morphology in over 90% of cases and fracture subtype in over 80% of cases according to the gold standard. Correct overall classification of fracture morphology (Assessment 1: P ¼ 0.024, Assessment 2: P ¼ 0.006) and subtype (P 2 < 0.001) differed significantly by years of experience but not by subspecialty. Conclusion. Overall, the Arbeitsgemeinschaft fu ¨r Osteosynthesefragen spine sacral classification system appears to be universally applicable among surgeons of various subspecialties and levels of experience with acceptable reliability, reproducibility, and accuracy.

Section: Discussionmentioning

confidence: 99%

The Influence of Surgeon Experience and Subspeciality on the Reliability of the AO Spine Sacral Classification System

Karamian

Levy

et al. 2021

Spine

“…The sagittal CT reconstruction has previously been shown to be the most sensitive imaging modality for the recognition of nondisplaced or minimally displaced sacral fractures 27. Patients without identifiable fractures on radiographs, in which there is a high clinical suspicion for sacral fracture, should undergo advanced imaging with either CT or magnetic resonance imaging (MRI).…”

Section: Imaging Diagnosismentioning

confidence: 99%

“…Whereas displaced lumbopelvic dissociations may be visible on lateral view radiographs, the C0 variant can be obscured (or not visible due to its lack of displacement) by the relatively cephalad location of the fracture and superimposed ilia. 27 In the original description of spinopelvic dissociation by Roy-Camille, 28 the lateral projection was noted for its importance in recognizing displacement and kyphotic deformity. Insufficiency fractures of the sacrum generally appear on plain radiographs as a sclerotic band with ill-defined borders.…”

Section: Imaging Diagnosismentioning

confidence: 99%

Management of C0 Sacral Fractures Based on the AO Spine Sacral Injury Classification

Lambrechts

Clinical Spine Surgery: A Spine Publication

Conaway

et al. 2022

The Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification hierarchically separates fractures based on their injury severity with A-type fractures representing less severe injuries and C-type fractures representing the most severe fracture types. C0 fractures represent moderately severe injuries and have historically been referred to as nondisplaced "U-type" fractures. Injury management of these fractures can be controversial. Therefore, the purpose of this narrative review is to first discuss the Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification System and describe the different fracture types and classification modifiers, with particular emphasis on C0 fracture types. The narrative review will then focus on the epidemiology and etiology of C0 fractures with subsequent discussion focused on the clinical presentation for patients with these injuries. Next, we will describe the imaging findings associated with these injuries and discuss the injury management of these injuries with particular emphasis on operative management. Finally, we will outline the outcomes and complications that can be expected during the treatment of these injuries.

“…Additionally, 42% had an injury to the abdominal viscera; 37% had a thoracic injury and 21% had a closed head injury. 41 Additionally, in a study analyzing 7 patients with U-shaped sacral fractures, Porrino and colleagues 42 identified associated pubic ramus fractures in 5, spine fractures in 4, visceral injuries in 3, lower limb fractures in 3, and upper limb fractures in 2 patients.…”

Section: Associated Injuriesmentioning

confidence: 99%

Sacral Fractures and Associated Injuries

Rodrigues-Pinto

Kurd

et al. 2017

Global Spine Journal

Study Design:Literature review.Objective:The aim of this review is to describe the injuries associated with sacral fractures and to analyze their impact on patient outcome.Methods:A comprehensive narrative review of the literature was performed to identify the injuries associated with sacral fractures.Results:Sacral fractures are uncommon injuries that result from high-energy trauma, and that, due to their rarity, are frequently underdiagnosed and mistreated. Only 5% of sacral fractures occur in isolation. Injuries most often associated with sacral fractures include neurologic injuries (present in up to 50% of sacral fractures), pelvic ring disruptions, hip and lumbar spine fractures, active pelvic/ abdominal bleeding and the presence of an open fracture or significant soft tissue injury. Diagnosis of pelvic ring fractures and fractures extending to the lumbar spine are key factors for the appropriate management of sacral fractures. Importantly, associated systemic (cranial, thoracic, and abdominopelvic) or musculoskeletal injuries should be promptly assessed and addressed. These associated injuries often dictate the management and eventual outcome of sacral fractures and, therefore, any treatment algorithm should take them into consideration.Conclusions:Sacral fractures are complex in nature and often associated with other often-missed injuries. This review summarizes the most relevant associated injuries in sacral fractures and discusses on their appropriate management.