mlroutt at u
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Aug 23, 2007, 8:38 PM
Post #6 of 6
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I have no experience with such injections.
Attempting to infuse lidocaine or other liquid substance into the dense
fibrous tissue of a sacral nonunion, especially the sacral body, seems
curious.
Chip
> How about trying to confirm that the sacral non-union is the source
> of the low back/sacral pain with CT-guided selective injection(s) of
> lidocaine with contrast into the pseudarthosis -- as mentioned by
> Kyle Dickson (last post) in a previous OTA case discussion of pain
> S/P pelvic injury.
> i.e. http://www.hwbf.org/hwb/conf/alex47/pelinj.htm
>
> Bill Burman, MD
> HWB Foundation
> http://www.hwbf.org
>
> -----------------------
>
>> Thank you...it might help to remove the disengaged and other iliosacral
>> screws then insert longer lag screws into the upper sacral segment and if
>> anatomically feasible into the second sacral segment as well.
>>
>> You could do it percutaneously and even add an electrical stimulation device
>> if that seems reasonable.
>>
>> At this point, I'd ignore the right pubic root issue if asymptomatic.
>>
>> If simple measures such as those above fail, then you could remove it all,
>> take down the sacral fracture site, refix with alternate techniques, and
>> bone graft.
>>
>> Chip
>>
>>
>>> Here is a magnified view. Sorry about the quality but the CT was scanned
>>> into our system.
>>> File is slightly large in order to preserve resolution
>>>
>>> dave
>>>
>>>
>>> ________________________________________________________________________
>>> ____________________________
>>>
>>> David P. Zamorano, MD
>>> Director, Orthopaedic Trauma Service
>>> UCI Medical Center
>>> (714) 456-7801 Office
>>> (714) 456-7547 Fax
>>>
>>> -----Original Message-----
>>> From: ORT-L-owner@www2.aaos.org [mailto:ORT-L-owner@www2.aaos.org] On
>>> Behalf Of Chip Routt
>>> Sent: Thursday, August 23, 2007 7:28 AM
>>> To: ORT-L@www2.aaos.org
>>> Subject: Re: [ORT-L] Sacral Non-Union
>>>
>>> Maybe remove the disengaged iliosacral screw first to see if she
>>> improves?
>>>
>>> I can't see the axial CT images well enough to detail the potential
>>> sacral issues....can you magnify them?
>>>
>>> Chip
>
>
>>>> Subject: Sacral nonunion
>>>> Date: Wed, 22 Aug 2007 10:14:44 -0700
>>>> From: "Zamorano, David" <dzamoran@uci.edu>
>>>>
>>>> Looking for advice.
>>>>
>>>> This is a 48 yo non-smoking female s/p MCC 10 months ago. I do not
>>>> have the initial injury films. She underwent ORIF as shown on
>>>> attached file. She is having continued pain in low back/sacral region.
>>>
>>>> Worse with sitting and prolonged walking. Has had pain since surgery.
>>>
>>>> All of her wounds have healed uneventfully. Also has right hip pain
>>>> laterally. No groin pain. Not aggravated with ROM of the hip.
>>>> Infection work-up has been negative.
>>>>
>>>> Any thoughts on the broken plate on the pelvic brim and the non-union
>>>> on the anterior column. Doesn't seem like she's have pain from there.
>>>>
>>>> Suggestions on treatment of sacral nonunion.
>>>>
>>>> Thanks
>>>> dave
>>>> _________________
>>>>
>>>> David P. Zamorano, MD
>>>> Director, Orthopaedic Trauma Service
>>>> UCI Medical Center
>>>> (714) 456-7801 Office
>>>> (714) 456-7547 Fax
>>>
>>> M.L. Chip Routt, Jr.,M.D.
>>> Professor-Orthopedic Surgery
>>> Harborview Medical Center
>>> 325 Ninth Avenue
>>> Box 359798
>>> Seattle, WA 98104-2499
>>> phone 206-731-3658
>>> FAX 206-731-3227
>>
>> M.L. Chip Routt, Jr.,M.D.
>> Professor-Orthopedic Surgery
>> Harborview Medical Center
>> 325 Ninth Avenue
>> Box 359798
>> Seattle, WA 98104-2499
>> phone 206-731-3658
>> FAX 206-731-3227
>> --
>>
>>
>>
>> ---
>> [This E-mail scanned for viruses by Declude Virus]
> ---
> [This E-mail scanned for viruses by Declude Virus]
>
M.L. Chip Routt, Jr.,M.D.
Professor-Orthopedic Surgery
Harborview Medical Center
325 Ninth Avenue
Box 359798
Seattle, WA 98104-2499
phone 206-731-3658
FAX 206-731-3227
--
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