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You can choose from the provided color combinations or create your own. © 2013 PosterPresentations.com 2117 Fourth Street, Unit C Berkeley CA 94710 posterpresenter@gmail.com Incidence Rare- 0.3 per 100,000 1 Common with other injuries to pelvic ring Mechanism High-energy trauma – young patients Motor vehicle accidents Car versus pedestrian Jump/fall from height Low-energy falls – elderly osteopenic patients Prognosis Dependent on amount of neuro compression Importance 30% missed upon initial examination 2 polytrauma or poor visualization of sacrum Spinopelvic dissociation increases risk of neural injury Introduction 5 fused vertebrae Makes up posterior portion of pelvic ring Transmits body weight from spine to pelvis Nerves exit through sacral foramina Ala (wing) is common site for sacral fractures Segments fuse at puberty Anatomy CT is gold standard for diagnosing sacral fracture 5 view pelvic films can be helpful and easier to obtain Traditional inlet and outlet views have been described as 45° for inlet and outlet Recent studies have shown 20-25° inlet and 40-60° outlet to provide superior visualization 4,5 Important for intraoperative placement of ilio-sacral screws Imaging Very few sacral fractures can be managed nonoperatively, but most can be fixed using either ilio-sacral screw placement in simple fracture patterns or triangular osteosynthesis in spinoplevic dissocaition fracture patterns. 6,7 Surgical stabilization also allow earlier ambulation after injury, improving recovery times. 2 Surgical Fixation Summary References Contacts/Acknowledgments Michael A. Robbins 1 BS, Daniel T. O’Conner 1 BS, Jonathan G. Eastman 1 MD, Eric O. Klineberg 1 MD 1 Department of Orthopaedic Surgery, UC Davis School of Medicine, Sacramento, CA, USA Fractures of the Sacrum Classifications 3 The sacrum is the bone that forms the connection between the spine and pelvis and allows passage of the nerve roots which extend down from cauda equina. Sacral fractures are a rare injury most commonly seen in high energy polytrauma patients. This easily missed fracture pattern requires a high index of suspicion and advanced imaging to identify most cases. Chances of neurologic injury vary by fracture pattern which correlates with Denis classification. Advances in imaging and surgical techniques have improved identification and fixation of these injury patterns. In the presence of spinopelvic dissociation, complex surgical fixation spanning from the pelvis to the spine is necessary. Prognosis depends on severity of neural deficit upon initial presentation. 1.Bydon M, De la Garza-Ramos R, Macki M, Desai A, Gokaslan AK, Bydon A. Incidence of sacral fractures and in-hospital postoperative complications in the United States: an analysis of 2002-2011 data. Spine. 2014;39(18):E1103-1109. 2.Mehta S, Auerbach JD, Born CT, Chin KR. Sacral fractures. The Journal of the American Academy of Orthopaedic Surgeons. 2006;14(12):656- 665. 3.Mehta S, Auerbach JD, Born CT, Chin KR. Sacral fractures. The Journal of the American Academy of Orthopaedic Surgeons. 2006;14(12):656- 665 4.Eastman JG, Chip Routt ML, Jr. Correlating preoperative imaging with intraoperative fluoroscopy in iliosacral screw placement. Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology. 2015 5.Ricci WM, Mamczak C, Tynan M, Streubel P, Gardner M. Pelvic inlet and outlet radiographs redefined. The Journal of bone and joint surgery. American volume. 2010;92(10):1947-1953. 6.Nork SE, Jones CB, Harding SP, Mirza SK, Routt ML, Jr. Percutaneous stabilization of U-shaped sacral fractures using iliosacral screws: technique and early results. Journal of orthopaedic trauma. 2001;15(4):238-246. 7.Tim Pohlemann UC. Pelvic Ring. In: Thomas P Ruedi REB, Christopher G Moran, ed. AO Principles of Fracture Management. Vol 2 - Specific Fractures. Second Expanded Edition ed. Switzerland, Clavadelerstrasse 8, CH-7207: AO Pubishing; 2007:697-717 Thank you to my mentors Dr. Klineberg and Dr Eastman and my colleague D. O’Conner for their contributions to this work. Denis Classification A-6% neural injury B-28% neural injury C-60% neural injury Sacral Fracture Patterns Roy-Camille Classification Isler Classification- fractures relative to facets Iliosacral screw placementTriangular Osteosynthesis Case example showing AP and Saggital view with both iliosacral screw and triangular osteosynthesis