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    Sacral Fractures

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    puchio
    Sacral Fractures

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    Sacral Fractures

    Uploaded by

    puchio
    970 views4 pages
    Sacral Fractures

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    Sacral Fractures

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    970 views4 pages

    Sacral Fractures

    Uploaded by

    puchio
    Sacral Fractures

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    Sacral Fractures

    Often occurring in conjunction with pelvic ring injuries, sacral fractures are
    often diagnosed late and can be associated with neurologic compromise.

    Overview

    • Usually high-energy (often MVA) trauma or low-energy insufficiency fractures


    • 1/3 missed on initial evaluation, so need high suspicion *IMPORTANT*
    • Associated with injuries to the pelvis, cauda equina, lumbosacral and sacral
    plexuses, sciatic nerve, iliac vessels

    History

    • Mechanism of injury? (Helps to aid in identifying other concomitant injuries)


    • Other musculoskeletal injuries?
    • Neurologic deficits, including bowel or bladder dysfunction?
    • Other areas of pain along the spine?

    Physical Exam

    • Monitoring of hemodynamic status


    • Trauma evaluation (Appendix A)
    • Thorough pelvic, abdominal, and urologic examination (± gynecologic exam for
    women)

    © Springer International Publishing Switzerland 2017 91


    M.C. Makhni et al. (eds.), Orthopedic Emergencies,
    DOI 10.1007/978-3-319-31524-9_25
    92 M.C. Makhni et al.

    • Presence of Morel-Lavallee lesion (lumbosacral degloving injury with palpable


    subcutaneous tissue)
    • Complete neurologic assessment (including rectal tone, peri-anal wink and sen-
    sation, and bulbocavernosus reflex)
    • ABIs (± angiogram if abnormal ABI)

    Diagnosis

    Imaging

    • Trauma series (including AP Pelvis, pelvic inlet, and outlet views)


    • Lumbosacral X-rays (Fig. 1)
    • CT pelvis/sacrum
    • MRI to visualize neural compromise

    Classification

    • Denis Classification (Fig. 2):


    ◦ Zone 1: lateral to foramina
    – Most common
    – Least likely for nerve injury (to L5)

    Fig. 1 Sacral fractures


    Sacral Fractures 93

    Fig. 2 Sacral fracture Denis classification

    ◦ Zone 2: through foramina


    – Unstable if shear component
    – Risk for nonunion and poor function
    ◦ Zone 3: medial to foramina
    – Most have neurologic deficit
    – Subcategories 1–4
    • Classification by letter resembled by fracture (e.g.: H, U, T, lambda)
    • H-shaped, U-shaped = spondylo-pelvic dissociation
    ◦ Likely neurologic deficit
    ◦ High mortality rate
    • Transverse: likely neurologic deficit, especially if proximal sacrum affected

    Treatment

    • Management of associated pelvic ring injury (see Chapter “Pelvic Ring Injury”)
    94 M.C. Makhni et al.

    Nonoperative Treatment

    • WBAT, pain control


    • Indications: maintained soft tissues, neurologically intact, and stable pelvis

    Surgical Treatment

    • Surgical Goals:
    ◦ Reduction of fracture/dislocation, with indirect neural decompression
    ◦ Direct neural decompression (laminectomy, foraminotomy)
    ◦ Soft-tissue coverage
    • Surgical Options:
    ◦ Decompression
    ◦ Open vs. percutaneous reduction/stabilization (e.g.: sacro-iliac, lumbo/
    sacral-pelvic)
    • Indications:
    ◦ Associated lumbosacral instability or unilateral facet dislocation
    ◦ Lumbosacral spondylolisthesis
    – Bilateral facet dislocations
    – Unilateral facet fracture dislocations
    – Trans-sacral fractures
    ◦ Neurologic deficit with compression
    ◦ Sacral fractures with poor integrity soft-tissue envelope

    References

    Kuklo TR, Potter BK, Ludwig SC, Anderson PA, Lindsey RW, Vaccaro AR, et al. Radiographic
    measurement techniques for sacral fractures consensus statement of the Spine Trauma Study
    Group. Spine (Phila Pa 1976). 2006;31(9):1047–55.
    Mehta S, Auerbach JD, Born CT, Chin KR. Sacral fractures. J Am Acad Orthop Surg.
    2006;14(12):656–65.

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