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Transverse Fracture and Dislocation at the Sacrum
We present a rare case of fracture-dislocation at the level of the first sacral (S1) and second sacral (S2) vertebrae.
The S1 was displaced forward into the pelvic cavity and was located just in front of the S2. Because the patient
also had extensive neurological injury to the lumbar plexus and instability of the pelvic ring, surgery to stabilize
the pelvis and to decompress the lumbar plexus was performed. The surgery was successful and the patient
experienced marked improvement in neurological function.
Transverse fracture of the sacrum is uncommon and accounts for only 2-5% of all sacral
. Concomitant dislocation of the sacrum, as was seen in our patient, is less
. In this report, we describe an uncommon case of fracture-dislocation of the sacrum
at the S1-S2 level and its operation and treatment, including a review of the literature.
A 54-year-old male presented with paraplegia and sensory loss of both lower extremities
following a fall injury. On admission, vital signs were normal. He showed decreased sensation
over the dorsal aspect and soles of the feet and along the lateral parts of the legs bilaterally.
Motor strength was grade 2/5 throughout both lower extremities. The patellar tendon reflex
and Achilles tendon reflex were diminished on both sides. In addition, anal sphincter tone and
sensation were absent.
Radiographic study was inconclusive. Computerized tomography (CT) showed a complete
fracture and dislocation at the S1-S2 level, with anterior displacement of the S1 body into the
pelvic cavity just in front of the S2 vertebra. It also showed a fracture of the body and ala of
the sacrum (Fig. 1). In addition, soft tissue and bony edemas were seen by magnetic resonance
imaging (MRI) (Fig. 2). With the patient in the prone position, the fracture and dislocation
site was approached through a
midline incision, which showed
a complete anterior dislocation
of S1 on S2.
Open reduction was attemp-
ted, but failed. We could not
reduce the dislocated S1 body
any further because of the
increasing risk of aggravating
the patientâ€™s neurological injury
and worsening his general con-
dition, so wide laminectomies
of S1 and S2 were performed
instead. During the procedure,
dural tearing and serpentine
spinal roots were seen. Injury to
the sacral nerve roots below
Transverse Fracture and
Dislocation at the Sacrum
J Korean Neurosurg Soc 43 : 31-33, 2008
In Uk Lyo, M.D. et al J Korean Neurosurg Soc 43 : 31-33, 2008
Type: Reference Material
Author/Contact: In Uk Lyo, M.D.
Institution: J Korean Neurosurg Soc
Submitted by: admin
Added: Wed Jul 15 2009