Operative outcomes and fracture patterns in dysmorphic sacrums

INTRODUCTION

Sacral dysmorphism has been previously reported to occur in 30 % to 40 % of adult patients. It has been described by 6 widely accepted parameters on outlet x-ray views of the pelvis: steep alar slope, retained S1-S2 disk, presence of mamillary bodies, sacralized L5, tongue in groove SI joint, and non-round neural foramina. Studies have focused on the importance of identifying dysmorphism for safe treatment of fractures in pelvises with dysmorphic upper sacral segments. Less is known regarding whether dysmorphism may be protective against trauma. To our knowledge no studies have focused on how dysmorphic sacrums fracture compared to non-dysmorphic (ND) sacrums, and whether operative rates are different.

AIMS

To assess the rate of operative fixation of sacral fractures between pelvises with dysmorphic and ND sacrums, as well as whether a difference exists in fracture morphology between groups.

DESIGN/METHODS

This is a retrospective cohort study out of a single level 1 trauma center. Study participants consisted of those sustaining a pelvic ring injury who were 18 years or older in which orthopaedics was consulted, had CT imaging available, and did not have isolated acetabulum fractures. 355 subjects were included of 671 reviewed pelvic ring injuries. Sacrums were deemed dysmorphic if they met at least one of the six dysmorphic features, and it was determined whether they underwent operative intervention. Fracture classifications and patterning were identified on CT imaging. P values were set <0.05.

RESULTS

We found that 44 % of inclusions had a dysmorphic sacrum with the most common feature to be a steep alar slope (68 %). 17.17 % of subjects with a ND sacrum underwent treatment versus 16.56 % for dysmorphic sacrums. No statistical difference regarding operative fixation rates was uncovered (p = .879). However, we found a difference in fracture patterns regarding ipsilateral posterior SI joint widening (p = 0.020).

CONCLUSION

Our study suggests that sacral dysmorphism is not protective against operative fixation based on no difference in operative rates between groups. However, our data supports that pelvises with dysmorphic sacrums may fracture differently based on the difference observed regarding other pelvic ring injuries.

Is only Anterior Stabilization Enough in Three-Column Injury of Subaxial Cervical Spine? - A Long-Term Retrospective Analysis of 78 Patients

Study Design:

This was a retrospective study.

Purpose:

The purpose was to retrospectively evaluate long-term outcome of anterior stabilization in three-column injury of the subaxial cervical spine.

Overview of Literature:

Literature shows varied results regarding the approach to be chosen. Most studies prefer a combined approach since biomechanically forms more stable construct. The isolated posterior approach is preferred by many as it is easy to reduce and fix three-column injuries. There are very few studies which show the isolated anterior approach to be better than the other two.

Materials and Methods:

Seventy-eight patients of three-column injury operated by anterior approach with follow-up of atleast 2 years were included and retrospectively analyzed. Clinical data included age, sex, time to surgery, methods of reduction, postoperative mobilization, and neurological evaluation using the ASIA scale. Radiological data included pre- and postreduction X-ray, computed tomography, and magnetic resonance imaging (MRI). X-rays taken post-operatively at 1,3, 6 months, 1yr and 2yrs. Variables like fracture type (AO Classification), overall alignment, localized kyphosis, time for fusion and grade of fusion mass were noted.

Results:

Of 78 patients, 61 had bifacetal dislocation and 17 unifacetal. The most common site was C5-6, followed by C3-4 and C6-7. The mean patient age was 35.98 years with 60 males and 18 females. The mean time to surgery was 4.4 days. Forty dislocations were reduced by closed method and 38 by open anterior approach. Fifty-six percent of patients had traumatic disc injury on MRI. All are managed by single-level anterior cervical discectomy and fusion with iliac crest autograft for fusion. The mean preoperative lordosis: 4.44° (range −13.4° to 25°) and mean postoperative lordosis: 28.57° (P < 0.0001) mean loss of alignment: 2.59° by 2 years, 100% fusion with mean time – 22.82 weeks, neurological recovery in 34.6% with atleast one grade improvement in ASIA scale. No neurological worsening or need for revision surgery was observed.

Conclusion:

The goal of surgery in cervical injury is bony stabilization and fusion using a least morbid approach and one with good long-term outcome. Above study concludes that only anterior stabilization after reduction of three-column injury would suffice with good long-term outcome, thereby obviating need for global fusion.