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Transverse Fracture and Dislocation at the Sacrum

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Location: http://synapse.koreamed.org/Synapse/Data/PDFData/0032JKNS/jkns-43-31.pdf

Description: 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.
31 INTRODUCTION Transverse fracture of the sacrum is uncommon and accounts for only 2-5% of all sacral fractures 1,2,4) . Concomitant dislocation of the sacrum, as was seen in our patient, is less common 5) . 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. CASE REPORT 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 patient’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
Primary Subject/Category:

Language: English

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Added: Wed Jul 15 2009