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Sacral fractures

Wenhao Song, Dongsheng Zhou, Yu He
BACKGROUND: The aim of this study was to compare the biomechanical characteristics between bilateral and unilateral lumbo-iliac fixation in unilateral comminuted sacral fractures (USF) by finite element analysis. METHODS: A 3-dimensional finite element model of unilateral sacral fractures was simulated. Three kinds of implants were instrumented into the model, including the unilateral lumbopelvic fixation (ULF), bilateral lumbopelvic fixation (BLF), and unilateral iliac fixation with bilateral lumbar pedicle screws (UBF)...
October 2016: Medicine (Baltimore)
Ismaeel Baba-Rasul, Hemin M Hama Ameen, Awder Khazendar, Seerwan O Hasan
BACKGROUND: Isolated lower segment sacral fracture is very rare. To the best of our knowledge, there is only one case report of S4 stable fracture that was treated conservatively. CASE DESCRIPTION: Here, we report a 12-year-old female child who sustained isolated S5 fracture with anterior displacement of S5 and coccyx on S4. The patient was initially provided with conservative management for one month and twenty-five days. On the failure of this treatment procedure, the patient was treated surgically by partial coccygectomy with S4-S5 fixation after reduction by two K-wires...
October 13, 2016: World Neurosurgery
Saud M Alfayez, Khalid Allimmia, Ahmad Alshammri, Firas Serro, Rakan Almogbel, Abdullah Bin Dous, Raed Almannie, Jesús Palencia
INTRODUCTION: Urological injuries in pelvic fractures are noticed in 6-15% of the cases. The bladder, due to its anatomical position, is prone to rupture in pelvic fractures. The majority of urinary bladder injuries are either extraperitoneal or intraperitoneal. Nonetheless, both types can occur simultaneously in 6% of the cases. PRESENTATION OF THE CASE: A 45-year-old male was brought to our emergency department after being struck by an automobile. In the absence of signs of urethral injury, a Foley's catheter was inserted revealing gross hematuria...
October 3, 2016: International Journal of Surgery Case Reports
Yann Philippe Charles, Axel Walter, Sébastien Schuller, Jean-Paul Steib
STUDY DESIGN: Prospective clinical trial in thoracolumbar trauma with 5-year follow-up. OBJECTIVE: To analyze clinical and radiographic outcomes of minimal invasive surgery, and the rational of circumferential fracture treatment with regard to age, degenerative changes, bone mineral density and global sagittal balance. SUMMARY OF BACKGROUND DATA: Non-neurologic fractures with anterior column defect can be treated by posterior percutaneous instrumentation and selective anterior fusion...
August 31, 2016: Spine
Pietro Giovanni di Summa, Clara Schaffer, Patrice Zaugg, Olivier Bauquis, Wassim Raffoul
We report the case of a 52-year-old man presenting an extensive lumbosacral necrosis after bilateral internal iliac arteries embolization following unstable pelvic fracture. Coverage of the defect was performed using two extended lumbar artery perforator flaps in a propeller fashion. Good functional and esthetic result was achieved at one-year follow-up.
2016: Case Reports in Plastic Surgery & Hand Surgery
Hosam E Matar, Kamran Hassan, Stephen P Duckett
No abstract text is available yet for this article.
2016: BMJ Case Reports
Niklas Grüneweller, Michael J Raschke, Ivan Zderic, Daniel Widmer, Dirk Wähnert, Boyko Gueorguiev, R Geoff Richards, Thomas Fuchs, Markus Windolf
Operative treatment of sacral insufficiency fractures is frequently being complicated by osteopenic bone properties. Cement augmentation of implanted sacroiliac screws may lead to superior construct stability and prevent mechanical complications. A novel hemi-pelvis test model with dissected symphysis was developed. Five fresh-frozen cadaveric pelvises were vertically osteotomized at the sacrum on both sides and fixed with sacroiliac screws in both corridors of the first sacral vertebral body. One side was randomly augmented with bone cement...
August 26, 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Yun Jung Choi, Won Seok Lee, Wan-Hee Yoo
No abstract text is available yet for this article.
September 2016: Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases
Amir Herman, Emily Keener, Candice Dubose, Jason A Lowe
Percutaneous sacral screw fixation is the mainstay of posterior pelvic ring fixation. This study quantifies the accuracy of fluoroscopic screw placement using post-operative CT scans and redefines the fluoroscopic safe zone using a mathematical calculation obtained from Inlet and outlet images. The authors hypothesized that a mathematical calculation of screw placement within the ala will improve accuracy of screw placement. A retrospective review of consecutive patients admitted to a level 1 trauma center with pelvic fractures fixed with iliosacral screws from January 2011 to December 2014 was performed...
August 23, 2016: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Drew Sanders, Joshua Fox, Adam Starr, Ashoke Sathy, John Chao
OBJECTIVES: To evaluate the effectiveness of transsacral-transiliac screw fixation for the treatment of sacral insufficiency fractures that fail nonoperative treatment. DESIGN: A pilot study series of consecutive patients identified over 5 years were treated and followed prospectively. SETTING: Academic-affiliated, tertiary referral, level 1 trauma center in Dallas, TX. PATIENTS/PARTICIPANTS: Patients were selected on the basis of presenting diagnosis, and failure of nonoperative treatment of their sacral insufficiency fracture...
September 2016: Journal of Orthopaedic Trauma
Woo Lam Jo, Woo Suk Lee, Dong Sik Chae, Ick Hwan Yang, Kyoung Min Lee, Kyung Hoi Koo
Subchondral insufficiency fracture (SIF) of the femoral head occurs in the elderly and recipients of organ transplantation. Osteoporosis and deficient lateral coverage of the acetabulum are known risk factors for SIF. There has been no study about relation between spinopelvic alignment and anterior acetabular coverage with SIF. We therefore asked whether a decrease of lumbar lordosis and a deficiency in the anterior acetabular coverage are risk factors. We investigated 37 patients with SIF. There were 33 women and 4 men, and their mean age was 71...
October 2016: Journal of Korean Medical Science
Suk Kang, Phil Hyun Chung, Jong Pil Kim, Young Sung Kim, Ho Min Lee, Gyeong Soo Eum
Percutaneous iliosacral screw fixation is commonly practiced to treat unstable posterior pelvic ring injuries. The number of reported cases of iatrogenic complications is increasing. We present a case of superior gluteal artery injury during bilateral percutaneous iliosacral screw fixation in a patient with sacral fracture of spino-pelvic dissociation. This complication was managed by arterial embolization. We discussed the cause, prevention and treatment of arterial injury along with a review of literature...
March 2015: Hip Pelvis
Gregory D Schroeder, Jason W Savage, Alpesh A Patel, Michael D Stover
No abstract text is available yet for this article.
March 24, 2015: JBJS Rev
Jeffrey W Miller, Art Diani, Steve Docsa, Kristi Ashton, Michele Sciamanna
INTRODUCTION: Percutaneous sacroplasty involves image-guided injection of bone cement for sacral insufficiency fractures to alleviate pain and facilitate mobility. Correct sacral placement of the cement and the risk of cement extravasation present procedural challenges. This study compares the occurrence, number, location, and surface area of high viscosity radiopaque bone cement extravasation via biplane fluoroscopy with Dyna CT between the fluoroscopically-guided intraoperative long-axis and short-axis sacroplasty techniques in osteoporotic cadavers...
July 25, 2016: Journal of Neurointerventional Surgery
John Tidwell, Rosa Cho, J Spence Reid, Henry Boateng, Carol Copeland, Edward Sirlin
Remembering that preoperative planning, surgical indications, and fracture reduction are paramount for this procedure, presented here is our technique for performing percutaneous sacroiliac screws, both transiliac-transsacral and sacral style. A combination of video, still pictures, and fluoroscopy images will guide the viewer through the process we routinely use highlighting specific details. Patient positioning and intraoperative fluoroscopy imaging are critical to a successful procedure. Although inlet and outlet films remain important, we find the procedure best started on the lateral sacral view to reduce the need for start site, trajectory, and imaging position changes during the case...
August 2016: Journal of Orthopaedic Trauma
Karan Malhotra, Joseph S Butler, Hai Ming Yu, Susanne Selvadurai, Shirley D'Sa, Neil Rabin, Charalampia Kyriakou, Kwee Yong, Sean Molloy
BACKGROUND: Multiple myeloma osteolytic disease affecting the spine results in vertebral compression fractures. These are painful, result in kyphosis, and impact respiratory function and quality of life. We explore the impact of time to presentation on the efficacy of spinal treatment modalities. METHODS: We retrospectively reviewed 183 patients with spinal myeloma presenting to our service over a 2 year period. RESULTS: Median time from multiple myeloma diagnosis to presentation at our centre was 195 days...
2016: BMC Cancer
Florian Gras, Heiko Gottschling, Manuel Schröder, Ivan Marintschev, Gunther O Hofmann, Rainer Burgkart
BACKGROUND: Percutaneous iliosacral screw placement is the standard procedure for fixation of posterior pelvic ring lesions, although a transsacral screw path is being used more frequently in recent years owing to increased fracture-fixation strength and better ability to fix central and bilateral sacral fractures. However, biomorphometric data for the osseous corridors are limited. Because placement of these screws in a safe and effective manner is crucial to using transsacral screws, we sought to address precise sacral anatomy in more detail to look for anatomic variation in the general population...
October 2016: Clinical Orthopaedics and related Research
Yi-Hsun Yu, Meng-Ling Lu, I-Chuan Tseng, Chun-Yi Su, Yung-Heng Hsu, Wen-Lin Yeh, Chi-Chung Wu
OBJECTIVE: To report the perioperative results and surgical outcomes of patients with vertical unstable sacral fractures who underwent lumbopelvic fixation through a modified subcutaneous route for iliac screw fixation. SUMMARY OF BACKGROUND DATA: Treating vertical unstable sacral fractures is still challenging for orthopedic surgeons. Among various methods for treating these fractures, lumbopelvic fixation provides a high reduction quality and promising stability for early weight-bearing ambulation...
June 23, 2016: Injury
Junichi Ohya, Todd D Vogel, Sanjay S Dhall, Sigurd Berven, Praveen V Mummaneni
S-2 alar iliac (S2AI) screw fixation has recently been recognized as a useful technique for pelvic fixation. The authors demonstrate two cases where S2AI fixation was indicated: one case was a sacral insufficiency fracture following a long-segment fusion in a patient with a transitional S-1 vertebra; the other case involved pseudarthrosis following lumbosacral fixation. S2AI screws offer rigid fixation, low profile, and allow easy connection to the lumbosacral rod. The authors describe and demonstrate the surgical technique and nuances for the S2AI screw in a case with transitional S-1 anatomy and in a case with normal S-1 anatomy...
July 2016: Neurosurgical Focus
Patrick C Hsieh, Praveen V Mummaneni
We are pleased to present this Neurosurgical Focus video supplement on lumbosacral and sacropelvic fixation strategies. Despite advancement in surgical techniques and technologies in spine, achieving consistent solid fusion across the lumbosacral junction remains a major challenge. The anatomy of the lumbosacral junction allows for a higher range of motion compared to other areas of the thoracolumbar spine. The L5-S1 interspace is exposed to significant shear forces. As a result, complications such as pseudoarthrosis, screw pull-out, implant fracture, or sacral fractures can occur...
July 2016: Neurosurgical Focus
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