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Sacral AND Fracture

Weera Chaiyamongkol, Apipop Kritsaneephaiboon, Piyawat Bintachitt, Sitthiphong Suwannaphisit, Boonsin Tangtrakulwanich
Study Design: Biomechanical study. Purpose: To investigate the relative stiffness of a new posterior pelvic fixation for unstable vertical fractures of the sacrum. Overview of Literature: The reported operative fixation techniques for vertical sacral fractures include iliosacral screw, sacral bar fixations, transiliac plating, and local plate osteosynthesis. Clinical as well as biomechanical studies have demonstrated that these conventional techniques are insufficient to stabilize the vertically unstable sacral fractures...
October 16, 2018: Asian Spine Journal
Horst Balling
STUDY DESIGN: Prospective single-center cohort study (non-inferiority study). OBJECTIVE: To compare clinical results of navigation-assisted screw fixation (NSF) to those of NSF with additional sacroplasty (NSF+SP) for immobilizing non-displaced insufficiency fractures of the sacrum. SUMMARY OF BACKGROUND DATA: Navigation-assisted screw fixation for sacral insufficiency fractures is a new, technically demanding procedure requiring surgical skills and experience...
October 11, 2018: Spine
Masaki Takao, Hidetoshi Hamada, Takashi Sakai, Nobuhiko Sugano
The purpose of this chapter is to review current evidence on indications, techniques, and outcomes of computer-navigated surgical treatment of pelvic ring injuries and acetabular fractures, particularly computer-navigated screw fixation.Iliosacral screw fixation of pelvic ring injury using navigation is attracting attention because the biomechanical stabilization of posterior pelvic ring disruption is of primary importance and is widely indicated because it does not require complete reduction of the fracture site...
2018: Advances in Experimental Medicine and Biology
T Pavelka, M Salášek
Anterior penetrating sacral injuries in children are extremely rare. These injuries are coupled with both a high energy mechanism (combat injury, motor vehicle accidents) and with foreign body impalement. The treatment is individual, laparotomy with penetrating wound exploration is indicated, osteosynthesis is performed in case of grossly displaced fractures, in an unstable injury to the posterior pelvic ring, and urgently in case of a neurological injury. The case report describes a 14-year-old girl with a left-sided anterior penetrating sacral injury at the level of S2/S3, who was injured during a bicycle accident (impalement on handlebars)...
2018: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Josephine Berger-Groch, Darius M Thiesen, Dimitris Ntalos, Lars G Grossterlinden, Eric Hesse, Florian Fensky, Maximilian J Hartel
BACKGROUND: Gold standard to diagnose osteoporosis is standard dual-energy X-ray absorptiometry (DXA). CT is a standard diagnostic tool to detect injuries to the pelvic ring. The aim of the study was to collect information on bone density without DXA by determination of Hounsfield units (HU) in CT scans of patients with sacral fractures, to draw conclusions on the prevalence of osteoporosis in patients admitted to the investigating institution. HYPOTHESIS: Is the determination of HU in CT scans a useful method to gain more information about bone density in patients with sacral fractures? PATIENTS AND METHODS: We performed a retrospective analysis of all patients treated from 2004-2014 with sacral fractures confirmed with a CT scan...
September 19, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Francesco Liuzza, Noemi Silluzio, Michela Florio, Omar El Ezzo, Gianpiero Cazzato, Gianluca Ciolli, Carlo Perisano, Giulio Maccauro
PURPOSE: The sacrum is a mechanical nucleus working as the base for the spinal column, as well as the keystone of the pelvic ring. Thus, injuries of the sacrum can lead to biomechanical instability and nerve conduction abnormality. METHODS: The common classification is the Denis classification, but these fractures are often part of a lesion of the posterior pelvic ring and therefore the Tile classification is very useful. The goals of operative intervention are to reduce fracture fragments, protect neurological structures, and provide adequate stability for early mobilization...
September 17, 2018: International Orthopaedics
Marc D Trust, Jacob Veith, Carlos V R Brown, John P Sharpe, Tashinga Musonza, John Holcomb, Eric Bui, Brandon Bruns, H Andrew Hopper, Michael Truitt, Clay Burlew, Morgan Schellenberg, Jack Sava, John Vanhorn, Brian Eastridge, Alicia M Cross, Richard Vasak, Gary Vercuysse, Eleanor E Curtis, James Haan, Raul Coimbra, Phillip Bohan, Stephen Gale, Peter G Bendix
BACKGROUND: There are no clear guidelines for the best test or combination of tests to identify traumatic rectal injuries. We hypothesize that computed tomography (CT) and rigid proctoscopy (RP) will identify all injuries. METHODS: American Association for the Surgery of Trauma multi-institutional retrospective study (2004-2015) of patients who sustained a traumatic rectal injury. Patients with known rectal injuries who underwent both CT and RP as part of their diagnostic workup were included...
September 11, 2018: Journal of Trauma and Acute Care Surgery
Benjamin R Pulley, Steven B Cotman, T Ty Fowler
OBJECTIVES: To define the incidence of the sacral U-type insufficiency fracture and describe management of a consecutive series of patients with this injury. DESIGN: Retrospective analysis. SETTING: Single level II trauma center. PATIENTS/PARTICIPANTS: Sixteen adult patients with sacral U-type insufficiency fractures treated over a 36-month period. INTERVENTION: Patients were indicated for percutaneous screw fixation of the posterior pelvis if they had posterior pelvic pain that prohibited mobilization...
August 23, 2018: Journal of Orthopaedic Trauma
Scott Huff, Marshall Gillette, Jacob Stirton, Nicholas Peters, Nabil Ebraheim
Abscess of the iliopsoas muscle is a rare condition that requires a high degree of clinical suspicion for diagnosis. High mortality rates highlight the need for prompt recognition. We report the case of a 26-year-old man, with a history of intravenous drug use, who was referred from an outside facility with sacral fracture and gluteal abscess. Sacral trauma occurred 3 weeks before presentation, with progressive worsening of buttock pain. The patient was treated with irrigation and débridement of the gluteal abscess...
December 2017: Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews
K Liang Zeng, Sten Myrehaug, Hany Soliman, Chia-Lin Tseng, Eshetu G Atenafu, Mikki Campbell, Salman Faruqi, Young K Lee, Mark Ruschin, Leodante da Costa, Victor Yang, Julian Spears, Chris Heyn, Pejman Jabehdar Maralani, Cari Whyne, Albert Yee, Arjun Sahgal
Background: The unique anatomy and biomechanical features of the cervical spine and sacrum may impact treatment outcomes following spine stereotactic body radiotherapy (SBRT). Current data for spine metastases are not specific for these locations. Objective: To report imaging-based SBRT outcomes to cervical and sacral metastases. Methods: We retrospectively reviewed our prospective spine SBRT database for cervical and sacral metastases. Patients were followed at 2- to 3-mo intervals with a clinical visit and full spine magnetic resonance imaging (MRI) and we report overall survival (OS), vertebral compression fracture (VCF), and MR imaging-based local control (LC) rates...
August 29, 2018: Neurosurgery
Wei Tian, Wen-Huan Chen, Jian Jia
OBJECTIVE: To evaluate the clinical outcomes of traumatic spino-pelvic dissociation (TSD) treated with modified bilateral triangular fixation. METHODS: Eighteen consecutive patients of TSD were included in the study from March 2011 to March 2015, and the medical records of patients were reviewed retrospectively. There were 14 men and 4 women with an average age of 33.1 ± 1.4 years (range, 18-55 years). A total of 16 cases were caused by falling, and 2 cases were caused by traffic accident...
August 2018: Orthopaedic Surgery
Tilman Bostel, Nils Henrik Nicolay, Thomas Welzel, Thomas Bruckner, Matthias Mattke, Sati Akbaba, Tanja Sprave, Jürgen Debus, Matthias Uhl
BACKGROUND: This study aimed to analyse the frequency and clinical relevance of sacral insufficiency fractures (SIFs) after high-dose carbon-ion based irradiation of sacral chordomas. METHODS: A total of 56 patients were included in this retrospective study. Twenty one patients (37%) were treated with definitive radiotherapy (RT), and 35 patients (63%) received postoperative RT using carbon ions, either in combination with photons or as single-modality treatment (median radiation dose 66 Gy RBE, range 60-74 Gy)...
August 23, 2018: Radiation Oncology
Yuan-Long Xie, Lin Cai, An-Song Ping, Jun Lei, Zhou-Ming Deng, Chao Hu, Xiao-Bing Zhu
U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently cause neurological deficits. The majority of surgeons have limited experience in management of U-shaped sacral fractures. No standard treatment protocol for U-shaped sacral fractures has been available till now. This study aimed to examine the management of U-shaped sacral fractures and the early outcomes...
August 2018: Current medical science
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
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