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Sacral AND Fracture

Geoffrey S Marecek, John A Scolaro
The evaluation and management of pelvic ring injuries continues to evolve. Historic treatment was primarily nonsurgical, which yielded to open surgical treatment as the benefits of restoring pelvic anatomy and stability became clear. The development of percutaneous techniques for pelvic ring fixation enabled surgeons to reduce and stabilize certain injuries without the need for large open surgical dissections. Although percutaneous iliosacral screw fixation of sacral fractures and sacroiliac disruptions is the standard for most posterior pelvic ring injuries, the evaluation and treatment of anterior pelvic ring disruptions remains a controversial topic among surgeons who treat these injuries...
September 2018: Journal of Orthopaedic Trauma
Badii Hmida, Soumaya Boudokhane, Houda Migaou, Amine Kalai, Anis Jellad, Zohra Ben Salah
RATIONALE: Stress fractures of the sacrum and mechanical sacroiliac joint disease can occur not only during pregnancy but also postpartum. Mechanical sacroiliac joint disease is common in patients with low back pain but often misdiagnosed by practitioners. The association of the 2 conditions has not been studied yet. PATIENT CONCERNS: A 37-year-old woman physiatrist presented with 8-week history of persistent low back and left buttock pain that started in the third trimester of her pregnancy...
August 2018: Medicine (Baltimore)
Jacob C Mandell, Bharti Khurana
PURPOSE: To explore clinical applications of a novel conventional computed tomography (CT) color post-processing algorithm to increase conspicuity of nondisplaced trabecular fractures. MATERIALS AND METHODS: The algorithm was created in Adobe Photoshop and Adobe Extendscript, utilizing DICOM images from conventional CT as source images. A total of six representative cases were selected and processed. No statistical analyses were performed. RESULTS: A total of six cases are demonstrated, five with MRI correlation demonstrating corresponding fractures and bone marrow edema, including a case of sacral insufficiency fracture, two cases of vertebral body fracture, two cases of nondisplaced hip fracture, and a knee bone marrow edema lesion (without MRI correlate)...
August 9, 2018: Emergency Radiology
Ryan Adams, Sarah Herrera-Nicol, Arthur L Jenkins
Background  Advancements in radiological imaging and diagnostic criteria enable doctors to more accurately identify lumbosacral transitional vertebrae (LSTV) and their association with back and L5 distribution leg pain. It is considered the most common congenital anomaly of the lumbosacral spine with an incidence between 4 and 35%, 3 although many practitioners describe 10 to 12% overall incidence. LSTVs include sacralization of the L5 vertebral body and lumbarization of the S1 segment while demonstrating varying morphology, ranging from broadened transverse processes to complete fusion...
July 2018: Journal of Neurological Surgery Reports
Jianzhong Zhang, Peng Zhang, Liyang Wu, Jun Su, Jianwu Shen, Hao Fan, Xiaodong Zhang
OBJECTIVE: To evaluate the feasibility and safety of an individualized and reassemblable three-dimensional (3D) printing navigation template for making accurate punctures during sacral neuromodulation (SNM). METHODS: From July 2016 to July 2017, 24 patients undergoing SNM were enrolled. Conventional X-ray guidance was used in the control group, which included 14 patients, while the 3D printing template was used in the experimental group, which included 10 patients...
July 27, 2018: Neurourology and Urodynamics
Ulrich Josef Albert Spiegl, Klaus John Schnake, Georg Osterhoff, Max J Scheyerer, Bernhard Ullrich, Philipp Bula, Holger Siekmann
Fractures of the os sacrum without relevant trauma history are defined as stress or insufficiency fractures and often affect the anterior pelvis. Sacral insufficiency fractures are associated with osteoporosis and occur under physiological load. In contrast, sacral stress fractures are caused by mechanical overloading. Diagnostic confirmation is delayed in many of these patients. Thus, MRI and/or CT should be performed early. Fracture stability should be evaluated by CT. MRI is the better approach to rule out fractures and is highly sensitive...
July 27, 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
Yoon Yi Kim, Bo Mi Chung, Wan Tae Kim
BACKGROUND: Sacral insufficiency fractures (SIFs) are a common cause of lower back pain in the elderly. However, because clinical symptoms are frequently vague and nonspecific and can mimic lumbar spine pathologies, initial imaging in SIF patients is frequently targeted at the lumbar spine rather than the sacrum, resulting in delayed diagnosis. The purpose of this study is to show the proportions of modalities used in diagnosing SIF in practice and to compare the clinical and imaging features of SIF diagnosed by lumbar spine MRI (L-spine MRI) with those diagnosed by non-lumbar imaging modalities (bone scan, pelvic bone CT, pelvis MRI)...
July 25, 2018: BMC Musculoskeletal Disorders
Josephine Berger-Groch, Marie Lueers, Johannes Maria Rueger, Wolfgang Lehmann, Darius Thiesen, Jan Philipp Kolb, Maximilian Johannes Hartel, Lars Gerhard Grossterlinden
INTRODUCTION: The objective of this study is to report the institutions experiences with standardized 2D computer-navigated percutaneous iliosacral screw placement (CNS), as well as the conventional fluoroscopically assisted screw placement method (CF) over a period of 10 years. PATIENTS AND METHODS: A total of 604 patients with sacral fractures (OTA B and C) were treated at the institution. Cases with both, a preoperative and postoperative CT scan were included for further analysis...
July 20, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Samuel R Brown, Carlos Fernandez, Robert Bertellotti, Juan Antonio Asensio
A 53-year-old man was admitted to our trauma center after sustaining thoracoabdominal injuries, secondary to a rear-end motor vehicle collision. As he stepped out of his vehicle, he was struck by a tractor trailer at 55 mph. The following were the initial vital signs on his arrival: heart rate 140 beats/min, blood pressure 142/80 mm Hg, respiratory rate 28 breaths/min, temperature 36.8°C, and oxygen saturation 93%. The Glasgow Coma Scale score was 15 and the Injury Severity Score was 59. He was evaluated and resuscitated per the advanced trauma life support protocols...
2018: Trauma surgery & acute care open
Ulrich J Spiegl, Brian M Devitt, Ihor Kasivskiy, Jan-Sven Jarvers, Christoph Josten, Christoph-Eckhard Heyde, Hannes M Fakler
INTRODUCTION: Surgical treatment of unstable burst fractures of the thoracolumbar spine in the elderly population is highly variable with combined posterior and anterior stabilization (CPAS) and posterior augmented stabilization with cementation of the vertebral body (hybrid) being two commonly used techniques. The aim of this study was to compare the clinical and radiographic outcomes of CPAS versus hybrid stabilization for the treatment of unstable burst fractures of the thoracolumbar spine in patients aged between 60 and 70 years...
July 14, 2018: Archives of Orthopaedic and Trauma Surgery
Hideto Irifune, Suguru Hirayama, Nobuyuki Takahashi, Mitsumasa Chiba, Toshihiko Yamashita
Background: Herein, we demonstrate the clinical results of closed reduction in a hyperextended supine position with transsacral-transiliac (TSTI) and iliosacral (IS) screw fixations for Denis zone III sacral fractures. Patients and Methods: Sixteen consecutive patients with Denis zone III sacral fractures who were treated between January 2009 and September 2016 were evaluated. All patients were treated using percutaneous TSTI/IS screw fixation during closed reduction performed with patients placed in a hyperextended supine position with body manipulation...
2018: Advances in Orthopedics
Daniela Nonne, A Capone, F Sanna, L Busnelli, A L Russo, G Marongiu, G Dessì, A Ferreli
BACKGROUND: Sacral fractures with spinopelvic dissociation are rare, and hard to diagnose and treat. Fractures with a H- or U-shaped line are severely unstable, due to a dissociation of the spine and of the upper body of the sacrum from the pelvis. They are commonly due to high-energy trauma events, with severe neurological injuries in 80% of cases. CASES PRESENTATION: Five polytraumatized Caucasian patients, three women and two men (mean age: 34 years old) with spinopelvic dissociation were selected...
June 26, 2018: Journal of Medical Case Reports
Joseph M Lombardi, Jamal N Shillingford, Lawrence G Lenke, Ronald A Lehman
The indications for sacropelvic fixation continue to evolve with emerging instrumentation technologies and advancing techniques. Common indications include long construct fusions, high-grade spondylolisthesis, sacral fractures, sacral tumors, and global sagittal and/or coronal imbalance among others. The authors' preferred technique is through use of a freehand S2-alar-iliac screw placement.
July 2018: Neurosurgery Clinics of North America
Shih-Chieh Yang, Tsung-Ting Tsai, Hung-Shu Chen, Chi-Jung Fang, Yu-Hsien Kao, Yuan-Kun Tu
PURPOSE: Sacral insufficiency fractures (SIFs) can cause severe lower back pain and immobility, which have limited therapeutic options. No previous studies have compared clinical outcomes and radiographic findings of sacroplasty with or without balloon assistance for the treatment of SIFs. METHODS: Forty-five patients with SIFs were divided into two groups. One group had 18 patients treated using sacroplasty with balloon assistance, and the other had 27 patients treated without balloon assistance...
May 2018: Journal of Orthopaedic Surgery
J Brock Walker, Sean M Mitchell, Sean D Karr, Jason A Lowe, Clifford B Jones
OBJECTIVE: To determine whether percutaneous transiliac-transsacral screw fixation improves pain, ambulation, length of stay, and the rate of disposition to home in patients with sacral fragility fractures. DESIGN: Retrospective cohort study. SETTING: Single academic level 1 trauma center. PATIENTS/PARTICIPANTS: Elderly patients who presented with an isolated sacral fragility fracture between August 2015 and August 2017...
July 17, 2018: Journal of Orthopaedic Trauma
Yonggang Li, Xiguang Sang, Zhiyong Wang, Lin Cheng, Hao Liu, Tao Qin, Kai Di
BACKGROUND: It is often difficult to achieve stable fixation in Tile type C1 pelvic fractures and there is no standard fixation technique for these types of injuries. HYPOTHESIS: Iliac screw fixation can be used for treating Type C1 pelvic fractures. PATIENTS AND METHODS: A retrospective review was performed on 47 patients who underwent iliac screw fixation in posterior column of ilium (PCI) for Tile type C1 pelvic fractures from July 2007 to December 2014...
June 18, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Abdelfattah M Saoud, Ahmed Mohamed Sallam
No abstract text is available yet for this article.
June 14, 2018: World Neurosurgery
Alex Quok An Teo, Jing Hui Yik, Sheldon Ng Jin Keat, Diarmuid Paul Murphy, Gavin Kane O'Neill
INTRODUCTION: Percutaneously-placed sacroiliac (SI) screws are currently the gold-standard fixation technique for fixation of the posterior pelvic ring. The relatively high prevalence of sacral dysmorphism in the general population introduces a high risk of cortical breach with resultant neurovascular damage. This study was performed to compare the accuracy of SI screw placement with and without the use of intraoperative navigation, as well as to externally validate the sacral dysmorphism score in a trauma patient cohort...
May 31, 2018: Injury
D H R Kempen, D Delawi, M C Altena, M C Kruyt, M P J van den Bekerom, F C Oner, R W Poolman
BACKGROUND: The purpose of this study was to determine the neurological outcome after transverse sacral fractures in patients with neurological impairment. METHODS: A systematic review of the English, French, German, and Dutch literature was conducted. All study designs, including retrospective cohort studies and case reports, describing transverse sacral fractures were included. Two authors independently extracted the predefined data and scored the neurological impairment according to the Gibbons classification after the trauma and at the time of follow-up...
June 2018: JBJS Reviews
Hidetatsu Tanaka, Go Yamako, Hiroaki Kurishima, Shutaro Yamashita, Yu Mori, Daisuke Chiba, Etsuo Chosa, Eiji Itoi
BACKGROUND: Supra-acetabular insufficiency fractures (SAIFs) occur in the upper acetabulum and are rare compared with insufficiency sacral, femoral head, or ischial fractures. However, SAIFs are known to occur in low grade trauma, and the underlying mechanism is still remained unclear. METHODS: We performed biomechanical analysis using finite element analysis to clarify the mechanisms underlying the development of SAIFs. Patient-specific models and bone mineral density (BMD) were derived from pelvic computed tomography data from two patients with SAIF (unaffected side) and two healthy young adults...
June 1, 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
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