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 ::  Abstract
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  References

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CASE REPORT
Year : 1995  |  Volume : 41  |  Issue : 2  |  Page : 47-9

Fracture sacrum.


Department of Orthopaedics, Dr R N Cooper Hospital, Juhu, Mumbai.

Correspondence Address:
A S Dogra
Department of Orthopaedics, Dr R N Cooper Hospital, Juhu, Mumbai.

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Source of Support: None, Conflict of Interest: None


PMID: 0010707711

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 :: Abstract 

An extremely rare case of combined transverse and vertical fracture of sacrum with neurological deficit is reported here with a six month follow-up. The patient also had an L1 compression fracture. The patient has recovered significantly with conservative management.


Keywords: Accidental Falls, Adult, Anus, innervation,Bladder, innervation,Case Report, Follow-Up Studies, Fracture Fixation, methods,Human, Immobilization, Lumbar Vertebrae, injuries,Male, Sacrum, injuries,Spinal Fractures, complications,diagnosis,therapy,Treatment Outcome,


How to cite this article:
Dogra A S, Karkhanis A R, Asurlekar R V. Fracture sacrum. J Postgrad Med 1995;41:47

How to cite this URL:
Dogra A S, Karkhanis A R, Asurlekar R V. Fracture sacrum. J Postgrad Med [serial online] 1995 [cited 2019 Aug 25];41:47. Available from: http://www.jpgmonline.com/text.asp?1995/41/2/47/497





  ::   Introduction Top


An extremely rare combination of both transverse with vertical fracture line was seen in our case. Sacral fractures are a rare entity by themselves and the incidence of these fractures are as low as 1.4%[1] of all spine fractures. Other series also report this low incidence of sacral fractures[2],[3]. Historically, transverse fractures have constituted about 5 to 10% of all sacral fractures[5] In 1945. Bonnin[5] stated that almost always transverse fractures occur as isolated injuries. Only 0.22% sustained a fracture of sacrum with secondary fracture of spine or extremity[1], as seen in our case.


  ::   Case report Top


A 24-year-old male had an accidental fall from the 3rd floor and sustained an injury around the sacral region. The patient had no other associated injury, no major illness or other contributory history and was brought to our hospital within 2 hours of sustaining the injury.

On examination, the patient had tenderness around the L1 region as well as the sacral region. Paraspinal muscle spasm was present around both the L 1-2 region as well as lumbo-sacral region. Specifically, the patient had no motor deficit however the patient had 90% hypoasthesia around the left perianal region (S3-4-5 dermatomes). The anal tone was decreased the bulbocavernous reflex weak at the left halt and the anal wink was absent.

In the next few hours, the patient had urinary as well as anal incontinence and thus the patient had to be catheterised. The patient had no pelvic injury and rest of the examination was unremarkable.

Plain X-rays revealed a transverse fracture at S 2,3 region with angulation anteriorly. [Figure:1] with a compression fracture of L1 vertebra. 3-D CT SCAN revealed not only a transverse fracture line but also a vertical fracture of the left half of S2-3-4 sacral foramen. [Figure:2]

Cystometrography revealed detrusor hypo-reflexia and partially uninhibited sphincter relaxation during simultaneous EMG recording.

The patient was treated conservatively in bed for a period of 6 weeks and then subsequently was permitted progressive mobilisation as much as the patient comfort permitted. No sit supports were used. At a 6 month follow-up, the patient had improved his deficit with conservative management by 80%. The patient had voluntary control of both bladder and bowel and anal tone was improved. The anal wink although present was sluggish as well as the hypo-asthesia in S3-4-5 derma-tomes was only 10-20%.


  ::   Discussion Top


It is noticed that fractures of sacrum are most frequently associated with a major fracture of pelvis. However, in our case the patient had no associated pelvis fracture and also our patient sustained a 10% compression fracture of L1 vertebra, which has an incidence of only 0.22%[1]. The low incidence of sacra) fractures as pointed out by Dennis and colleagues[6] are due to a large number of these fractures going unrecognised in major pelvic fractures.

The mechanism of injury producing isolated fractures of the sacrum is proposed to be direct trauma[1]. Also Roy-Camille[7] et al reported these fractures in association with suicide attempts.

Barnes’[3] review of literature noted that fracture of the sacrum were more often associated with angulation than with displacement. This was also noticed by Mayer[1]. There was angulation in our case as well and we do confirm the findings. This is most probably due to the levering action which is exerted through the distal segment of the sacrum below its level of fixation by the sacroiliac joint[4],[7]. It is also noticed by Byrnes[3] and Denis[8], that the fracture most frequently occurs at the transition between the thickened S1 and slightly thinner S2 segment and the narrower and thinner mid portion of the sacral body. The 3-Dimensional CT Scan made it possible to identity the extent of a fracture and the direction of its fracture lines.

Results from operative decompression remain debatable'. Nearly all deficits improve to some degree with time, although only occasionally is the functional restitution complete[10]. Weaver[8] recommends bed rest for 1 to 2 months in treating this injury to promote osseous healing of the fracture site and to avoid pseudarthrosis. Thus consistent with these references our patient did recover significantly and is painless with good stability.

 
 :: References Top

1. Meyer PR Jr. Fractures of the lumbar and sacral spine. Conservative and surgical management. In: PR Mayer Jr, editor. Surgery of Spine Trauma New York: Churchill Livingstone; 1989, pp 717-823.  Back to cited text no. 1    
2.Fardon DF Displaced transverse fracture of the sacrum with nerve root injury, report of a case with successful operative management J Trauma 1979; 19:119.  Back to cited text no. 2    
3.Byrnes DR, Russo GL. Sacrum fractures and neurological damage. J Neurosurg 1977, 47, 459.  Back to cited text no. 3    
4.Fountain SS, Hamilton Rd, Jameson RM. Transverse fractures of the sacrum J Bone Joint Surg 1977; 59A:486.  Back to cited text no. 4    
5.Bonnin JG. Sacral fractures and injuries to the cauda equina J Bone Joint Surg 1945; 2713:113.  Back to cited text no. 5    
6.Roy-Camille R. Transverse fractures of the upper sacrum suicidal jumpers fractures. Spine: 1985; 10:838.  Back to cited text no. 6    
7.Weaver EN. Sacral fracture Case presentation and review Neurosurgery 1981; 9:726.  Back to cited text no. 7    
8.Denis F, Davis S, Comfort T. Sacral fractures, an important problem, though frequently undiagnosed and untreated retrospective analysts of 236 consecutive cases Presentation Federation of Spine Associations AAOS, January 22 1987.  Back to cited text no. 8    
9.Dowling T, Epstein JA, Spstein NE. S1-S2 sacral fractures involving neural elements of the cauda equina. Spine, 1985; 10:851.  Back to cited text no. 9    
10.Schmidek HH, Smith DA, Kristiansen TK. Sacral fractures Issues of Neural Injury. Spinal Stability and Surgical Management. In: Dunsker SB, editor. The unstable spine. (Thoracic. lumber, and Sacral Regions). Florida Grune & Stratten Inc; 1986, pp 191-220.   Back to cited text no. 10    




 

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