1
|
Lee P, Chen YS, Singh A, Gardner A. Percutaneous iliosacral screw fixation of sacral U-type fracture using a mid-foot intramedullary bolt: a case report. Singapore Med J 2024:00077293-990000000-00070. [PMID: 38421122 DOI: 10.4103/singaporemedj.smj-2021-172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/24/2022] [Indexed: 03/02/2024]
Affiliation(s)
- Peng Lee
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore
| | | | | | | |
Collapse
|
2
|
Han T, Jiang Q. The "Hand as Foot" teaching method in the Denis and Roy-Camile classification of sacral fractures. Asian J Surg 2024; 47:825-826. [PMID: 37925286 DOI: 10.1016/j.asjsur.2023.10.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/13/2023] [Indexed: 11/06/2023] Open
Affiliation(s)
- Tieling Han
- Department of Orthopedics, Huhhot First Hospital, South Second Ring Road, Huhhot, Inner Mongolia Autonomous Region, 010030, China
| | - Qiting Jiang
- Orthopedic Center, Nanjing Jiangbei Hospital, Nanjing Jiangbei New District, Nanjing, Jiangsu Province, 210048, China.
| |
Collapse
|
3
|
Turbucz M, Pokorni AJ, Bigdon SF, Hajnal B, Koch K, Szoverfi Z, Lazary A, Eltes PE. Patient-specific bone material modelling can improve the predicted biomechanical outcomes of sacral fracture fixation techniques: A comparative finite element study. Injury 2023; 54:111162. [PMID: 37945416 DOI: 10.1016/j.injury.2023.111162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To evaluate and compare the biomechanical efficacy of six iliosacral screw fixation techniques for treating unilateral AO Type B2 (Denis Type II) sacral fractures using literature-based and QCT-based bone material properties in finite element (FE) models. METHODS Two FE models of the intact pelvis were constructed: the literature-based model (LBM) with bone material properties taken from the literature, and the patient-specific model (PSM) with QCT-derived bone material properties. Unilateral transforaminal sacral fracture was modelled to assess different fixation techniques: iliosacral screw (ISS) at the first sacral vertebra (S1) (ISS1), ISS at the second sacral vertebra (S2) (ISS2), ISS at S1 and S2 (ISS12), transverse iliosacral screws (TISS) at S1 (TISS1), TISS at S2 (TISS2), and TISS at S1 and S2 (TISS12). A 600 N vertical load with both acetabula fixed was applied. Vertical stiffness (VS), relative interfragmentary displacement (RID), and the von Mises stress values in the screws and fracture interface were analysed. RESULTS The lowest and highest normalised VS was given by ISS1 and TISS12 techniques for LBM and PSM, with 137 % and 149 %, and 375 % and 472 %, respectively. In comparison with the LBM, the patient-specific bone modelling increased the maximum screw stress values by 19.3, 16.3, 27.8, 2.3, 24.4 and 7.8 % for ISS1, ISS2, ISS12, TISS1, TISS2 and TISS12, respectively. The maximum RID values were between 0.10 mm and 0.47 mm for all fixation techniques in both models. The maximum von Mises stress results on the fracture interface show a substantial difference between the two models, as PSM (mean ± SD of 15.76 ± 8.26 MPa) gave lower stress values for all fixation techniques than LBM (mean ± SD of 28.95 ± 6.91 MPa). CONCLUSION The differences in stress distribution underline the importance of considering locally defined bone material properties when investigating internal mechanical parameters. Based on the results, all techniques demonstrated clinically sufficient stability, with TISS12 being superior from a biomechanical standpoint. Both LBM and PSM models indicated a consistent trend in ranking the fixation techniques based on stability. However, long-term clinical trials are recommended to confirm the findings of the study.
Collapse
Affiliation(s)
- Mate Turbucz
- School of PhD Studies, Semmelweis University, Budapest, Hungary; In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Agoston Jakab Pokorni
- School of PhD Studies, Semmelweis University, Budapest, Hungary; In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Sebastian Frederick Bigdon
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University Hospital, University of Bern, Switzerland
| | - Benjamin Hajnal
- School of PhD Studies, Semmelweis University, Budapest, Hungary; In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Kristof Koch
- School of PhD Studies, Semmelweis University, Budapest, Hungary; National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary
| | - Zsolt Szoverfi
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Aron Lazary
- National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary
| | - Peter Endre Eltes
- In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary; Department of Spine Surgery, Department of Orthopaedics, Semmelweis University, Budapest, Hungary.
| |
Collapse
|
4
|
Gahr P, Mittlmeier T. [Sacral H-shaped fractures between traumatic, insufficiency and fatigue fractures : Similarities, differences and controversies]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:863-871. [PMID: 37401983 DOI: 10.1007/s00113-023-01346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/05/2023]
Abstract
In the basic entirety of stress fractures, insufficiency fractures are defined as fractures caused by prolonged normal or physiological loading of a bone with insufficient elastic resistance. This clearly distinguishes it from fatigue fractures, in which excessive loads are continuously applied to a bone with normal elastic resistance. According to Pentecost (1964) both entities of stress fracture result from "the inherent inability of the bone to withstand stress applied without violence in a rhythmical, repeated, subthreshold manner". This distinguishes them from acute traumatic fractures. In the clinical routine these differences are not always so clearly presented. The example of the H‑shaped sacral fracture is used to illustrate the relevance of a clear terminology. In this context, current controversies in the treatment of sacral insufficiency fractures are discussed.
Collapse
Affiliation(s)
- Patrick Gahr
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
| | - Thomas Mittlmeier
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland
| |
Collapse
|
5
|
The efficacy of "TiRobot"orthopaedic robot-assisted VS conventional fluoroscopic percutaneous screw fixation of the sacroiliac joint. INTERNATIONAL ORTHOPAEDICS 2023; 47:351-358. [PMID: 36572784 PMCID: PMC9876857 DOI: 10.1007/s00264-022-05655-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/03/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE This study is to compare the precision and safety of the orthopaedic robot with conventional fluoroscopy for assisted percutaneous sacroiliac joint screw implantation. METHODS Retrospective analysis was performed on the clinical data of 57 patients with unstable posterior pelvic ring injuries who were admitted and met the criteria between January 2017 and January 2022. All of these patients underwent percutaneous sacroiliac joint screw implantation, and their clinical data were split into two groups based on the surgical technique: a RA group (robot-assisted implantation, 30 patients, 54 screws) and a CF group (conventional fluoroscopic freehand implantation, 27 patients, 42 screws). There were 96 screws placed in total. The durations of the two groups' operations, fluoroscopy examinations, fluoroscopy doses, total number of fluoroscopies, and intra-operative guide pin applications were noted and compared. On post-operative CT scans, the placement of each screw was assessed using the Gertzbein-Robbins classification. Finally, imaging Matta criteria were used to assess the sacroiliac joint fracture reduction. The Majeed functional score was used to assess clinical function. RESULTS Both groups successfully completed 57 procedures in total. In both groups, there were no consequences from vascular injury, wound infection, or urinary tract infection. Additionally, there were no complications from robotic-induced nerve injury, operating time, fluoroscopic dose, and the frequency of fluoroscopic; the number of percutaneous punctures in the RA group was lower than that of the CF group.There were statistically significant differences between the aforementioned data (P < 0.05). The modified Matta evaluated the effectiveness of fracture reduction. In the RA group, there was no statistically significant difference between the CF group (P > 0.05). According to the modified Gertzbein-Robbins classification criteria, the 54 screws implanted in the RA group were classified as follows: class A (45), class B (5), class C (4), and class D (0); the accuracy rate of the implants was 92.59%. Forty-two screws implanted in the CF group, 30 screws were defined class A, class B (3), class C (7), and class D (2). The accuracy rate of the implants was 78.57%(χ2 = 3.967, P < 0.05). There was a statistically significant difference between the two groups. The Majeed score 30 patients in RA group, one month post-operation, 16 considered exceptional, eight decent, six moderate, and zero bad. Post-operation more than six months,25 recorded exceptional, five decent. By the time,27 patients in CF group,12 exceptional grade, eight decent, six moderate, and one bad,one month post-operation. Post-operation more than six months,22 recorded exceptional, five decent.Both group (P > 0.05). CONCLUSION "TiRobot" robot-assisted screw implant treatment for unstable posterior pelvic ring injury has a greater success rate than traditional surgery as compared to conventional percutaneous screw implant. It is a precise, secure, and minimally invasive surgical technique that can also be applied to severe pelvic injuries even congenital sacral deformities.
Collapse
|
6
|
Shi B, Peng Y, Zhang G, Zhang S, Luo Y, Lv F, Hu Y, Zhang L. Spinopelvic dissociation: extended definition, physical examination, classification, and therapy. J Orthop Surg Res 2023; 18:56. [PMID: 36658546 PMCID: PMC9854108 DOI: 10.1186/s13018-023-03523-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Spinopelvic dissociation (SPD) is generally caused by high-energy injury mechanisms, and, in the absence of timely diagnosis and treatment, it can lead to chronic pain and progressive deformity. However, SPD is difficult to manage because of its rarity and complexity. In this study, we re-defined SPD according to the mechanism of injuries and biomechanical characteristics of the posterior pelvic ring and developed new classification criteria and treatment principles based on the classification for SPD. METHODS Between June 2015 and September 2020, 30 patients with SPD which were selected from 138 patients with pelvic fractures were enrolled. Physical examination was performed, classification criteria (301 SPD classification) were developed, and specific treatment standards were established according to the classifications. RESULTS The injury mechanisms and co-existing injuries did not significantly differ between the classical SPD patients and expanded SPD patients. The 301 SPD classification criteria covered all the patients. Fixation by biplanar penetration screws was used in 7 patients, 11 patients received fixation by uniplanar penetration screws, 6 patients used sacroiliac compression screws, 3 patients received uniplanar screws combined with sacroiliac compression screws, and open spondylopelvic fixation was used in only 3 patients. According to the Matta criteria, 19, 7, and 4 patients achieved excellent, good, and fair reduction. The Majeed function score of the patients ranged from 9 to 96 points, and the mean score was 72.9 ± 24.6 points. CONCLUSION The expanded definition for SPD is particularly significant for definite diagnosis and prevention of missing diagnosis, based on which the 301SPD classification criteria can more systemically guide the clinical treatment of SPD, increase the treatment efficacy, and reduce surgical trauma. Chinese Clinical Trial Registry: ChiCTR-IPR-16009340.
Collapse
Affiliation(s)
- Bin Shi
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853 People’s Republic of China
| | - Ye Peng
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853 People’s Republic of China
| | - Gongzi Zhang
- grid.414252.40000 0004 1761 8894Department of Rehabilitation Medicine, Chinese PLA General Hospital, Beijing, 100853 People’s Republic of China
| | - Shuwei Zhang
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853 People’s Republic of China
| | - Yang Luo
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853 People’s Republic of China
| | - Faqin Lv
- grid.414252.40000 0004 1761 8894Department of Ultrasonography, The No. 3 Medical Center of Chinese PLA General Hospital, Beijing, 100039 People’s Republic of China
| | - Ying Hu
- grid.9227.e0000000119573309Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055 People’s Republic of China
| | - Lihai Zhang
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853 People’s Republic of China
| |
Collapse
|
7
|
Zheng J, Liu F, Xiang J, Leung FKL, Feng X, Chen B. Biomechanical investigation of S2 alar-iliac screw and S1 pedicle screw fixation in the treatment of Denis type II sacral fractures. J Orthop Res 2023; 41:215-224. [PMID: 35441729 DOI: 10.1002/jor.25336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023]
Abstract
Although S2 alar-iliac screw technique has been widely used in spinal surgery, its applicability to pelvic fractures is largely unknown. This study aimed to evaluate the biomechanical stability of S2 alar-iliac screw and S1 pedicle screw fixation in the treatment of Denis II sacral fractures. Twenty-eight artificial pelvic fracture models were treated with unilateral lumbopelvic fixation, sacroiliac screw fixation, S2 alar-iliac screw and S1 pedicle screw fixation, and S2 alar-iliac screw and contralateral S1 pedicle screw fixation (Groups 1-4, respectively; N = 7 per group). Each model was cyclically tested under increasing axial compression. Optical motion-tracking was used to assess relative displacement and gap angle, and the number of failure cycles. Relative displacement was significantly smaller in Group 3 than in Groups 1 (p = 0.004) and 4 (p < 0.001) but not significantly different between Groups 3 and 2 (p = 0.290). The gap angle in Group 3 was significantly smaller than that in Group 1 (p = 0.009) on the sagittal plane but significantly larger than that in Group 4 (p = 0.006) on the horizontal plane. A number of failure cycles was significantly higher in Group 3 than in Groups 1 (p = 0.002) and 4 (p = 0.004) but not significantly different between Groups 3 and 2 (p = 0.910). From a biomechanical perspective, S2 alar-iliac screw and S1 pedicle screw fixation can provide good stability in the treatment of Denis II sacral fractures.
Collapse
Affiliation(s)
- Jianxiong Zheng
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fei Liu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Xiang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Frankie K L Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Xiaoreng Feng
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
8
|
Abstract
CT is often performed as part of a whole-body protocol in the setting of polytrauma and is the standard of care for diagnosing and characterizing sacral fractures. These fractures are not uncommon, occurring in conjunction with pelvic ring disruption in approximately 40%-50% of patients. Knowledge of basic functional anatomy and fracture biomechanics is important in understanding sacral fracture patterns, which only rarely result from direct impact. More often, sacral fractures result from an indirect mechanism with fracture lines that propagate along relative lines of weakness, leading to predictable fracture patterns. Each fracture pattern has implications with respect to neurologic injury, spinopelvic stability, management, and potential complications. The authors explore the Denis, Roy-Camille, Isler, Robles, Sabiston-Wing, and shape-based classification systems for sacral fractures. These form the basis of the subsequently discussed unified AOSpine sacral fracture classification, a consensus system developed by spine and orthopedic surgeons as a means of improving and standardizing communication. The AOSpine sacral fracture classification also includes clinical designations for neurologic status and patient-specific modifiers. When a patient is unexaminable owing to obtundation or sedation, CT is an invaluable indirect marker of nerve compression or traction injury. It also plays an important role in visualizing and characterizing the type and extent of any associated soft-tissue injuries that may warrant a delay in surgery or an alternative operative approach. ©RSNA, 2022.
Collapse
Affiliation(s)
- David Dreizin
- From the Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| | - Elana B Smith
- From the Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, 655 W Baltimore St, Baltimore, MD 21201
| |
Collapse
|
9
|
Muacevic A, Adler JR. Navigated Percutaneous Sacroiliac Screw Fixation in Unstable Pelvic Ring Fracture. Cureus 2022; 14:e29897. [PMID: 36348881 PMCID: PMC9631861 DOI: 10.7759/cureus.29897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 01/24/2023] Open
Abstract
Since the late 1990s, navigation systems have been widely used in a variety of orthopaedic surgical procedures, with the majority of these procedures being complex arthroplasty surgeries and the correction of spinal abnormalities. Navigation systems are, however, infrequently used in trauma cases, especially in unstable pelvic ring fractures. The conventional method of percutaneous sacroiliac screw fixation typically used fluoroscopic image intensifiers to fix unstable pelvic ring fractures. We will examine how navigation systems can be used in trauma situations, particularly those involving unstable posterior pelvic ring fractures and focus on the advantages and disadvantages that we experienced during management.
Collapse
|
10
|
Vereecke E, Herregods N, Morbée L, Laloo F, Chen M, Jans L. Imaging of Structural Abnormalities of the Sacrum: The Old Faithful and Newly Emerging Techniques. Semin Musculoskelet Radiol 2022; 26:469-477. [PMID: 36103888 DOI: 10.1055/s-0042-1754342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The sacrum and sacroiliac joints pose a long-standing challenge for adequate imaging because of their complex anatomical form, oblique orientation, and posterior location in the pelvis, making them subject to superimposition. The sacrum and sacroiliac joints are composed of multiple diverse tissues, further complicating their imaging. Varying imaging techniques are suited to evaluate the sacrum, each with its specific clinical indications, benefits, and drawbacks. New techniques continue to be developed and validated, such as dual-energy computed tomography (CT) and new magnetic resonance imaging (MRI) sequences, for example susceptibility-weighted imaging. Ongoing development of artificial intelligence, such as algorithms allowing reconstruction of MRI-based synthetic CT images, promises even more clinical imaging options.
Collapse
Affiliation(s)
- Elke Vereecke
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Nele Herregods
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Lieve Morbée
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Frederiek Laloo
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Min Chen
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| |
Collapse
|
11
|
Kanaan T, Alisi M, Hijazein Y, Naneh Y, Kheshman A, Hadadin H, Dahabreh D, Hadidi F, Al-Sabbagh Q. Management of a rare case of isolated U-shaped displaced sacral fracture in a young female high school student. Trauma Case Rep 2022; 40:100664. [PMID: 35721661 PMCID: PMC9204385 DOI: 10.1016/j.tcr.2022.100664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 02/08/2023] Open
Abstract
Sacral fractures in young healthy patients are usually linked to high-energy trauma. They are often associated with multiple other injuries. Isolated sacral fractures are rare and can be easily missed in the absence of other surrounding pelvic or spinal injuries. In this article, we present a rare case of isolated U-shaped displaced sacral fracture despite the high-energy mechanism of injury being missed on initial presentation. This is a 17-year-old healthy female who presented to the emergency department after falling from five-meter height. She complained of lower back pain and inability to ambulate. Physical examination revealed significant sacral tenderness, bilateral lower limb weakness and hypoesthesia, anesthesia of the saddle area, weak anal tone and absent anal reflex. Initial radiographs showed no apparent fractures. Further imaging by pelvic computed tomography, however, revealed an isolated U-shaped displaced sacral fracture. The patient was treated by decompression and lumbopelvic fixation by triangular osteosynthesis and iliosacral screw. This fixation method restored stability of the spinopelvic junction and allowed for early mobilization. At her 18-month follow-up visit, she showed minimal disability score (10%) on the Oswestry Disability Index. In conclusion, sacral fractures are considered exceedingly rare to occur in isolation and in young healthy patients.
Collapse
Affiliation(s)
- Tareq Kanaan
- Department of Neurosurgery, University of Jordan, Amman, Jordan
- Corresponding author at: Department of Neurosurgery, University of Jordan, Queen Rania St., Amman, Jordan.
| | - Mohammed Alisi
- Department of Orthopedic Surgery, University of Jordan, Amman, Jordan
| | - Yazan Hijazein
- Department of Neurosurgery, University of Jordan, Amman, Jordan
| | - Yazan Naneh
- Department of Neurosurgery, University of Jordan, Amman, Jordan
| | | | - Hiba Hadadin
- Department of Neurosurgery, University of Jordan, Amman, Jordan
| | - Dina Dahabreh
- Department of Neurosurgery, University of Jordan, Amman, Jordan
| | - Fadi Hadidi
- Department of Orthopedic Surgery, University of Jordan, Amman, Jordan
| | | |
Collapse
|
12
|
Li J, Yu XK, Tian W, Dong XM, Guo L, Li XF. The clinical value of using magnetic resonance contrast-enhanced three-dimensional nerve view in the diagnosis and management of sacral fracture accompanied by sacral plexus injury. Technol Health Care 2022; 30:1407-1415. [PMID: 35661030 DOI: 10.3233/thc-213543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The treatment of sacral fractures accompanied by nerve injury is complex and often leads to an unsatisfactory prognosis and poor quality of life in patients. OBJECTIVE The present study aimed to investigate the clinical value of using 3.0T magnetic resonance contrast-enhanced three-dimensional (MR CE-3D) nerve view magnetic resonance neurography (MRN) in the diagnosis and management of a sacral fracture accompanied by a sacral plexus injury. METHODS Thirty-two patients with a sacral fracture accompanied by a sacral plexus injury, including 24 cases of Denis spinal trauma type II and 8 cases of type III, were enrolled in the study. All patients had symptoms or signs of lumbosacral nerve injury, and an MRN examination was performed to clarify the location and severity of the sacral nerve injury. Segmental localization of the sacral plexus was done to indicate the site of the injury as being intra-spinal (IS), intra-foraminal (IF), or extra-foraminal (EF), and the severity of the nerve injury was determined as being mild, moderate, or severe. Surgical nerve exploration was then conducted in six patients with severe nerve injury. The location and severity of the nerve injury were recorded using intra-operative direct vision, and the results were statistically compared with the MRN examination results. RESULTS MRN showed that 81 segments had mild sacral plexus injuries (8 segments of IS, 20 segments of IF, 53 segments of EF), 78 segments had moderate sacral plexus injuries (8 segments of IS, 37 segments of IF, and 33 segments of EF), and 19 segments had severe sacral plexus injuries (7 segments of IS, 9 segments of IF, and 3 segments of EF). The six patients who underwent surgery had the following intra-operative direct vision results: 3 segments of moderate injury (IF) and 20 segments of severe injury (7 segments of IS, 10 segments of IF, 3 segments of EF). There was no statistically significant difference in the results between the intra-operative direct vision and those of the MRN examination (p> 0.05). CONCLUSION MR CE-3D nerve view can clearly and accurately demonstrate the location and severity of sacral nerve injury accompanied by a sacral fracture, and has the potential for being the first choice of examination method for this kind of injury, which would be of important clinical value.
Collapse
Affiliation(s)
- Jian Li
- Department of Radiology, Tianjin Hospital, Tianjin, China.,Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Xiao-Kun Yu
- Department of Radiology, The Fifth Centre Hospital of Tianjin City, Tianjin, China.,Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Wei Tian
- Department of Traumatic Orthopaedics, Tianjin Hospital, Tianjin, China
| | - Xiao-Man Dong
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Lin Guo
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Xiao-Feng Li
- Department of Radiology, Tianjin Hospital, Tianjin, China
| |
Collapse
|
13
|
Qi H, Geng X, Yu X, Chen W, Jia J, Tian W. Posterior INFIX for Treating Unilateral Unstable Sacral Fractures. Orthop Surg 2022; 14:750-757. [PMID: 35343061 PMCID: PMC9002066 DOI: 10.1111/os.13251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/29/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the clinical outcomes of the treatment of unilateral unstable sacral fractures by fixation with the posterior INFIX (posterior pelvic ring screw‐rod internal fxation). Methods Data of 60 patients with unilateral unstable sacral fractures who underwent surgery from March 2013 to March 2020 were retrospectively analyzed according to the selection criteria. All patients were associated with anterior pelvic ring injuries, and the operations were performed by the same team of surgeons. According to the different types of internal fixation, the patients were divided into two groups, which both included 30 patients: the posterior INFIX group and iliosacral screw fixation group. The demographic and clinical data of the two patient groups, such as age, sex, sacral fracture types based on the Denis classification, operation time, amount of intraoperative bleeding, intraoperative fluoros copy time, Majeed pelvic score at final follow‐up, and quality of fracture reduction based on Mears and Velyvis's imaging classification criteria were collected by the same researcher and compared statistically. Results All patients were continuously followed up for 23.17 ± 3.34 months (range, 12 to 46 months). All sacral fractures healed with an average healing time of 9.3 ± 2.24 months (range, 6 to 18 months). None of the patients had re‐displacement of the fracture or fixation failure. Compared to the iliosacral screw group, the posterior INFIX group patients had more intraoperative bleeding (t = 3.59, P < 0.001), shorter operation time (t = 4.49, P < 0.001), and shorter intraoperative fluoroscopy time (t = 6.26, P < 0.001). There were no statistical differences between the two groups in terms of age, sex, fracture type, Majeed score, and quality of fracture reduction (P > 0.05). In the posterior INFIX group, one patient had a superficial wound infection and one patient complained of discomfort due to a prominent fixation. In the iliosacral screw fixation group, one patient had intraoperative iatrogenic S1 nerve injury and vessel injury. The posterior INFIX fixation was a simpler manipulation with higher safety, shorter time of operation and intraoperative fluoroscopy, and similar clinical outcomes compared to iliosacral screw fixation. Conclusion For the treatment of unilateral unstable sacral fractures, the posterior INFIX fixation can be recommended in clinic application.
Collapse
Affiliation(s)
- Haotian Qi
- Department of Orthopaedic Trauma, Tianjin Hospital, Tianjin, China
| | - Xin Geng
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Xiaokun Yu
- Department of Radiology, The Fifth Centre Hospital of Tianjin City, Tianjin, China
| | - Wenhuan Chen
- Third Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jian Jia
- Department of Orthopaedic Trauma, Tianjin Hospital, Tianjin, China
| | - Wei Tian
- Department of Orthopaedic Trauma, Tianjin Hospital, Tianjin, China
| |
Collapse
|
14
|
Zheng J, Xiang J, Zheng J, Feng X, Chen B. Treatment of Unstable Posterior Pelvic Ring Injury with S2-Alar-Iliac Screw and S1 Pedicle Screw Fixation. World Neurosurg 2021; 158:e1002-e1010. [PMID: 34896346 DOI: 10.1016/j.wneu.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/03/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The S2-alar-iliac (S2AI) screws have been described as an alternative method for lumbosacropelvic fixation in place of iliac screws. However, the clinical effect of the short-segment S2AI screw fixation technique in the treatment of unstable posterior pelvic ring injuries remains unclear. In this study, we report the preliminary clinical results of the internal fixation connecting a S2-alar-iliac screw and a S1 pedicle screw (i.e., S2AI-S1 fixation) in the treatment of unstable pelvic posterior ring injuries. METHODS Twenty-five patients with unstable posterior pelvic ring injury were treated with S2AI-S1 fixation from February 2019 to June 2020. The incision length, surgical time, blood loss, frequency of intraoperative fluoroscopy, quality of reduction, complications, and functional outcome were analyzed. RESULTS A total of 29 groups of S2AI-S1 fixation were used in 25 patients. The mean incision length was 8.3 (6.2 - 10.3) cm, mean operative time was 86.4 (60 - 142) minutes, mean frequency of intraoperative fluoroscopy was 7.9 (4 - 12) times, and mean blood loss was 148 (50 - 500) mL. The mean postoperative follow-up time was 17.8 (10 - 26) months. The satisfaction rate of pelvic reduction quality was 25/29, and the satisfactory rate of functional outcome was 23/25. There were no obvious signs of screw prominence, screw loosening, or implant failure. CONCLUSIONS The case series presented in this study show the successful use of S2AI-S1 fixation to treat unstable posterior pelvic ring injuries. The S2AI-S1 fixation, not including the lumbar spine in the fixation range, is a simple, safe, and effective fixation method.
Collapse
Affiliation(s)
- Jianxiong Zheng
- Department of Orthopaedics, Division of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jie Xiang
- Department of Orthopaedics and Traumatology, the First Affiliated Hospital of University of South China, Hengyang, China
| | - Jianping Zheng
- Department of Orthopaedics, HuiZhou First Hospital, Huizhou, China
| | - Xiaoreng Feng
- Department of Orthopaedics, Division of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Chen
- Department of Orthopaedics, Division of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| |
Collapse
|
15
|
Zheng J, Feng X, Xiang J, Liu F, Leung FKL, Chen B. S2-alar-iliac screw and S1 pedicle screw fixation for the treatment of non-osteoporotic sacral fractures: a finite element study. J Orthop Surg Res 2021; 16:651. [PMID: 34717718 PMCID: PMC8557573 DOI: 10.1186/s13018-021-02805-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background Five different sacral fracture fixation methods were compared using finite element (FE) analysis to study their biomechanical characteristics. Methods Denis type I sacral fractures were created by FE modeling. Five different fixation methods for the posterior pelvic ring were simulated: sacroiliac screw (SIS), lumbopelvic fixation (LPF), transiliac internal fixator (TIFI), S2-alar-iliac (S2AI) screw and S1 pedicle screw fixation (S2AI-S1) and S2AI screw and contralateral S1 pedicle screw fixation (S2AI-CS1). Four different loading methods were implemented in sequence to simulate the force in standing, flexion, right bending and left twisting, respectively. Vertical stiffness, relative displacement and change in relative displacement were recorded and analyzed. Results As predicted by the FE model, the vertical stiffness of the five groups in descending order was S2AI-S1, SIS, S2AI-CS1, LPF and TIFI. In terms of relative displacement, groups S2AI-S1 and S2AI-CS1 displayed a lower mean relative displacement, although group S2AI-CS1 exhibited greater displacement in the upper sacrum than group S2AI-S1. Group SIS displayed a moderate mean relative displacement, although the displacement of the upper sacrum was smaller than the corresponding displacement in group S2AI-CS1, while groups LPF and TIFI displayed larger mean relative displacements. Finally, in terms of change in relative displacement, groups TIFI and LPF displayed the greatest fluctuations in their motion, while groups SIS, S2AI-S1 and S2AI-CS1 displayed smaller fluctuations. Conclusion Compared with SIS, unilateral LPF and TIFI, group S2AI-S1 displayed the greatest biomechanical stability of the Denis type I sacral fracture FE models. When the S1 pedicle screw insertion point on the affected side is damaged, S2AI-CS1 can be used as an appropriate alternative to S2AI-S1. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02805-8.
Collapse
Affiliation(s)
- Jianxiong Zheng
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Xiaoreng Feng
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China.,Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, 5/f, Professorial Block, Pok Fu Lam Road, Pok Fu Lam, Hong Kong SAR, China.,Department of Orthopaedics and Traumatology, Yangjiang People's Hospital, Yangjiang, China
| | - Jie Xiang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Fei Liu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Frankie K L Leung
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, 5/f, Professorial Block, Pok Fu Lam Road, Pok Fu Lam, Hong Kong SAR, China.
| | - Bin Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| |
Collapse
|
16
|
Minimally invasive triangular lumboiliac and iliosacral fixation of posterior pelvic ring injuries with vertical instability: Technical note. Orthop Traumatol Surg Res 2021; 107:102993. [PMID: 34186218 DOI: 10.1016/j.otsr.2021.102993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 12/08/2020] [Accepted: 01/18/2021] [Indexed: 02/03/2023]
Abstract
To date, no strong consensus exists on the best way to treat posterior pelvic ring injuries when there is no neurological deficit. Various fixation methods have been described; more recently, constructs that combine lumboiliac and iliosacral fixation have been introduced. This type of fixation is mainly indicated in cases of spinopelvic dissociation with large displacement of fracture fragments in the sagittal plane. However, these techniques are associated with postoperative complications, particularly infections and severe skin complications. This led us to propose a minimally invasive lumboiliac and iliosacral fixation technique for posterior pelvic ring injuries. The procedure is done with the patient prone. It consists of pedicle screw insertion into L4 or L5 and screw fixation of the ilium with fluoroscopy guidance; intraoperative distraction can be done depending on the amount of displacement. An iliosacral screw is then inserted percutaneously to allow reduction in the transverse plane and yield a triangular construct. In the five patients that we have operated using this technique, the mean preoperative vertical displacement was 11.9±6.9mm (SD) (min 1.3, max 19.7) versus 3.7±3.2mm (min 0.3, max 6.7) postoperatively and the mean preoperative frontal displacement was 7.5±3.7mm (min 4.2, max 12.4) versus 2.5±2.0mm (min 0.3, max 4.3) postoperatively. Minimally invasive iliosacral and lumboiliac fixation is an option for treating posterior pelvic ring fractures free of neurological deficit and especially spinopelvic dissociation.
Collapse
|
17
|
Huang H, Xing W, Zeng C, Huang W. Pararectus approach combined with three-dimensional printing for anterior plate fixation of sacral fractures. Injury 2021; 52:2719-2724. [PMID: 32430192 DOI: 10.1016/j.injury.2020.03.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/26/2020] [Accepted: 03/29/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Surgical treatment of sacral fractures is difficult, both for reduction and stabilization. Traditional surgical reduction and internal fixation require a long duration of operation leading to extra blood loss, extensive tissue damage, and increased risk of post-operation complications. The purpose of this study was to evaluate the feasibility of a minimally invasive technique that could be more effective, more tissue sparing, and lead to less bleeding. We hypothesized that a Pararectus approach for anterior fixation of unstable sacral fractures would be reliable and more advantageous and significantly improve the outcome of sacral fracture repair. METHODS Twelve patients with unstable sacral fractures were recruited and examined by CT scanning. A 3D model of each sacral fracture was reconstructed. The computer-assisted 3D image of the reduced pelvis was 3D printed for surgery simulation and plate pre-bending. All cases were treated operatively with the anterior anatomical reduction and internal fixation via a minimally invasive Pararectus approach. VAS, Matta, and Majeed scores were used to evaluate outcomes of the operation. RESULTS Pre-operations were consistent with the actual surgeries in all cases. The pre-bent plates had an anatomical shape specifically fit to the individual pelvis without further adjustment at the time of surgery, and fracture reductions were significantly improved with little invasive tissue damage. The average operation time was 110 min. The intraoperative blood loss and incision length averaged 695 ml and 6.7 cm, respectively. A high percentage of all cases achieved a diaplasis with an excellent or good score according to the Matta and Majeed standards (83.33% and 91.67%, respectively).All patients achieved clinical healing with an average healing time of 8 weeks. CONCLUSION 3D printing-assisted anterior fixation of unstable sacral fractures via a minimally invasive Pararectus approach is feasible. This new surgical strategy minimizes trauma damage and bleeding and produces satisfactory reduction and therapeutic efficacy.
Collapse
Affiliation(s)
- Huajun Huang
- The Third Affiliated Hospital of Southern Medical University(Academy of Orthopedics·Guangdong Province), Guangzhou, Guangdong, 510630, China; Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Shunde, Guangdong, 528308, China
| | - Weirong Xing
- Musculoskeletal Disease Center, Jerry L. Pettis Memorial VA Medical Center, Research Service, 11201 Benton St, Loma Linda, CA 92357, USA
| | - Canjun Zeng
- The Third Affiliated Hospital of Southern Medical University(Academy of Orthopedics·Guangdong Province), Guangzhou, Guangdong, 510630, China.
| | - Wenhua Huang
- The Third Affiliated Hospital of Southern Medical University(Academy of Orthopedics·Guangdong Province), Guangzhou, Guangdong, 510630, China; National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China; Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, 510515, China; Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangzhou, Guangdong, 510515, China.
| |
Collapse
|
18
|
Gierig M, Liu F, Weiser L, Lehmann W, Wriggers P, Marino M, Saul D. Biomechanical Effects of a Cross Connector in Sacral Fractures - A Finite Element Analysis. Front Bioeng Biotechnol 2021; 9:669321. [PMID: 34124023 PMCID: PMC8188498 DOI: 10.3389/fbioe.2021.669321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Spinopelvic fractures and approaches of operative stabilization have been a source of controversial discussion. Biomechanical data support the benefit of a spinopelvic stabilization and minimally invasive procedures help to reduce the dissatisfying complication rate. The role of a cross connector within spinopelvic devices remains inconclusive. We aimed to analyze the effect of a cross connector in a finite element model (FE model). Study Design: A FE model of the L1-L5 spine segment with pelvis and a spinopelvic stabilization was reconstructed from patient-specific CT images. The biomechanical relevance of a cross connector in a Denis zone I (AO: 61-B2) sacrum fracture was assessed in the FE model by applying bending and twisting forces with and without a cross connector. Biomechanical outcomes from the numerical model were investigated also considering uncertainties in material properties and levels of osseointegration. Results: The designed FE model showed comparable values in range-of-motion (ROM) and stresses with reference to the literature. The superiority of the spinopelvic stabilization (L5/Os ilium) ± cross connector compared to a non-operative procedure was confirmed in all analyzed loading conditions by reduced ROM and principal stresses in the disk L5/S1, vertebral body L5 and the fracture area. By considering the combination of all loading cases, the presence of a cross connector reduced the maximum stresses in the fracture area of around 10%. This difference has been statistically validated (p < 0.0001). Conclusion: The implementation of a spinopelvic stabilization (L5/Os ilium) in sacrum fractures sustained the fracture and led to enhanced biomechanical properties compared to a non-reductive procedure. While the additional cross connector did not alter the resulting ROM in L4/L5 or L5/sacrum, the reduction of the maximum stresses in the fracture area was significant.
Collapse
Affiliation(s)
- Meike Gierig
- Institute of Continuum Mechanics, Leibniz University Hannover, Hanover, Germany
| | - Fangrui Liu
- Institute of Continuum Mechanics, Leibniz University Hannover, Hanover, Germany
| | - Lukas Weiser
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, Göttingen, Germany
| | - Wolfgang Lehmann
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, Göttingen, Germany
| | - Peter Wriggers
- Institute of Continuum Mechanics, Leibniz University Hannover, Hanover, Germany
| | - Michele Marino
- Department of Civil Engineering and Computer Science, University of Rome Tor Vergata, Rome, Italy
| | - Dominik Saul
- Department of Trauma, Orthopedics and Reconstructive Surgery, Georg-August-University of Göttingen, Göttingen, Germany.,Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN, United States
| |
Collapse
|
19
|
Khil EK, Choi I, Choi JA, Kim YW. A modified MRI protocol for the increased detection of sacrococcygeal fractures in patients with thoracolumbar junction fractures. Sci Rep 2021; 11:5628. [PMID: 33707558 PMCID: PMC7952901 DOI: 10.1038/s41598-021-85167-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 02/22/2021] [Indexed: 12/19/2022] Open
Abstract
This study aimed to identify concurrent thoracolumbar junction (TLJ) and sacrococcygeal (SC) fractures using a modified MRI protocol and analyze the risk factors associated with tandem fractures. We retrospectively investigated patients with MRI-confirmed TLJ fractures from January 2017 to March 2020. Patients were divided into two study groups: study 1 with a modified MRI protocol and study 2 with a routine protocol. The modified protocol included an extended field of view of sagittal scans in L-spine MRI covering the full SC spine. In study 1, frequency of concurrent TLJ and SC fractures was investigated. And we analyzed risk factors and compared CT and MRI for detecting SC fractures. In study 2, co-occurrence of both fractures was investigated. A total of 176 and 399 patients with TLJ fractures were enrolled in study 1 and 2, then SC fractures were identified in 53 (30.14%) and 36 patients (9.02%), respectively. An axial loading trauma mechanism was a significant risk factor (Odds ratio 7.0, p < 0.001), and MRI was more sensitive than CT in detecting SC fractures (p < 0.002). Thus, a modified MRI protocol was useful to detect the high occurrence of SC fractures in TLJ fractures, which concurrent fractures increased by an axial loading mechanism.
Collapse
Affiliation(s)
- Eun Kyung Khil
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea
| | - Il Choi
- Department of Neurological Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea.
| | - Jung-Ah Choi
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea
| | - Young Woo Kim
- Department of Orthopeadic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, South Korea
| |
Collapse
|
20
|
Gutierrez-Gomez S, Wahl L, Blecher R, Olewnik Ł, Iwanaga J, Maulucci CM, Dumont AS, Tubbs RS. Sacral fractures: An updated and comprehensive review. Injury 2021; 52:366-375. [PMID: 33187674 DOI: 10.1016/j.injury.2020.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/02/2020] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
Sacral fractures are often underdiagnosed but are relatively frequent in the setting of pelvic ring injury. Causes include traumatic insults and osteoporosis. Sacral fractures have become more frequent owing to the growth of the elderly population worldwide as osteoporosis is an age-related disease. Misdiagnosed and neglected sacral fractures can result in chronic back pain, spine deformity, and instability. Unfortunately, the wide range of classification systems hinders adequate communication among clinicians. Therefore, a complete understanding of the pathology, and communication within the interdisciplinary team, are necessary to ensure adequate treatment and satisfactory clinical outcomes. The aim of this manuscript is to present the current knowledge available regarding classification systems, clinical assessment, decision-making factors, and current treatment options.
Collapse
Affiliation(s)
- Santiago Gutierrez-Gomez
- Pontificia Universidad Javeriana, Bogotá, Colombia; Center for Research and Training in Neurosurgery - CIEN; Samaritan University Hospital, Neurosurgery, Bogotá, Colombia
| | - Lauren Wahl
- Department of Cell and Developmental Biology, University of Colorado, Boulder, CO, USA
| | - Ronen Blecher
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - Łukasz Olewnik
- Department of Normal and Clinical Anatomy, Medical University of Lodz, Poland
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Christopher M Maulucci
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada; Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
| |
Collapse
|
21
|
Abstract
Sacral fractures are a heterogeneous group of fractures occurring in young people following road traffic accidents and falls from height, or in the elderly with osteoporosis following trivial trauma.This heterogeneity, combined with the low incidence of sacral fractures, determines a lack of experience amongst physicians, often leading to misdiagnosis, underestimation and inadequate treatment. The diagnosis should be made by assessing specific features during the clinical presentation, while computed tomography (CT) scan continues to be the choice of investigation.Sacral fractures can be treated non-operatively or surgically. Non-operative treatment is based on rest, pain relief therapy and early mobilization as tolerated. Surgical techniques can be split into two main groups: posterior pelvic fixation techniques and lumbopelvic fixation techniques. Anterior pelvic fixation techniques should be considered when sacral fractures are associated with anterior pelvic ring injuries, in order to increase stability and reduce the risk of posterior implant failure. To improve fracture reduction, different solutions could be adopted, including special positioning of the patient, manipulation techniques and use of specific reduction tools. Patients suffering from spinopelvic dissociation with associated neurologic lesions hardly ever recover completely, with residual lower-limb neurologic sequelae, urinary problems and sexual disfunction.Herein, we present issues, challenges and solutions related to the management of sacral fractures. Cite this article: EFORT Open Rev 2020;5:299-311. DOI: 10.1302/2058-5241.5.190064.
Collapse
Affiliation(s)
- Emmanuele Santolini
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Italy.,Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, UK
| | | | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, UK.,NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
| |
Collapse
|
22
|
Bagheri H, Govsa F. Anatomical considerations of safe drilling corridor upper sacral segment screw insertion. J Orthop 2019; 16:543-551. [PMID: 31660021 PMCID: PMC6806658 DOI: 10.1016/j.jor.2019.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022] Open
Abstract
The upper segment of sacrum is an important for screw insertions of unstable lumbosacral spine. Measurements of the S1-S2 as sacral wings, pedicles, sacral foraminas and sacral canal were taken from 87 sacrums. The mean depths of S1 pedicle and sacral wing were estimated as 25.8 ± 2.3 mm and 50.1 ± 1.7 mm, respectively. Angles screw trajectory of sacral pedicle anteromedial and sacral wing were measured as 29.6 ± 0.9° and 29.7 ± 2.1°, respectively. To avoid injury to the vascular structures anteriorly and nerve roots medially, depth and angle of screw trajectory is important for the entrance off pedicular screw placement to the S1.
Collapse
Affiliation(s)
| | - Figen Govsa
- Department of Anatomy Digital Imaging and 3D Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, Turkey
| |
Collapse
|
23
|
Classification of fractures of the coccyx from a series of 104 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:2534-2542. [PMID: 31637549 DOI: 10.1007/s00586-019-06188-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/02/2019] [Accepted: 10/13/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE To describe a classification of fractures of the coccyx, according to their mechanism. METHODS A series of 104 consecutive patients with a fracture of the coccyx was studied. The mechanism, level, characteristics of the fracture line and complications were recorded. RESULTS Three mechanisms are proposed to describe these fractures: flexion, compression and extension (types 1, 2 and 3, respectively). Flexion fractures (38 cases) involved the upper coccyx in 35 cases, and in 3 cases with a perineal trauma, it was the lower coccyx; compression fractures (24 cases) involved the middle coccyx and occurred only when Co2 was square or cuneiform and Co3 was long and straight, hence a nutcracker mechanism; four patients were adolescents with a compression of the sacrum extremity and were labeled adolescent compression fracture of S5 (type 2b); extension fractures (38 cases) were obstetrical and involved the lower coccyx; their key feature was a progressive separation of the fragments with time. Flexion fractures usually healed spontaneously, but an associated intermittent luxation was possible. Nutcracker and obstetrical fractures were instable in their majority. CONCLUSIONS For the first time, a classification of fractures of the coccyx is presented. Each type exhibits specific features. This should help the clinician in the management of these patients. These slides can be retrieved under Electronic Supplementary Material.
Collapse
|
24
|
|
25
|
Balakrishnan S. Highlights from the scientific and educational abstracts presented at the ASER 2017 annual scientific meeting and postgraduate course. Emerg Radiol 2018; 25:219-225. [PMID: 29594817 DOI: 10.1007/s10140-018-1599-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/08/2018] [Indexed: 10/17/2022]
Abstract
The annual meeting of the American Society of Emergency Radiology (ASER) took place in Toronto, Canada, on September 6 through September 9, 2017. Attendees represented the USA as well as international emergency radiology communities, including those from academic, private practice, and teleradiology settings. There were several "members in training" in attendance as well. The meeting again featured the "Trauma Head to Toe" 2-day didactic course, highlighting various important topics on imaging of traumatic injuries. Scattered throughout the 4 days were several poster and case of the day presentations, scientific sessions, and self-assessment modules. The following is a summary of the educational posters and scientific papers.
Collapse
Affiliation(s)
- Sudheer Balakrishnan
- Department of Radiology, Division of Emergency Radiology, Keck Hospital of University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|