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Sacral Fractures
Published in Kelechi Eseonu, Nicolas Beresford-Cleary, Spine Surgery Vivas for the FRCS (Tr & Orth), 2022
Kelechi Eseonu, Nicolas Beresford-Cleary
There is superior displacement of the lateral sacral fracture. This likely represents a vertical shear-type pelvic injury. There is also a left L5 transverse process fracture. (L4 and L5 transverse process fractures can commonly be associated with vertical shear-type sacral fractures, particularly after high-velocity injuries.)
Management of osteoporotic pelvic fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Pol M. Rommens, Daniel Wagner, Alexander Hofmann
Short-term outcome data for sacroplasty are gratifying (43,44). Nevertheless, some critical remarks must be made. Although adequate stability seems to be restored, it remains unclear what happens with the sacral fracture itself. The cement, which is a foreign body located between the fracture fragments, may hinder bone healing. Moreover, vertical load while standing and walking leads to shearing forces in the vertical sacral fracture, which may hinder bone healing as well. Sacroplasty restores some stability in the posterior pelvic ring but not in the anterior. The vast majority of fragility fractures of the pelvis have a combination of a fracture of the posterior pelvic ring with a fracture of the anterior pelvic ring. The anterior pelvic ring remains interrupted and unstable. Stabilization of the anterior pelvic ring should at least be taken into consideration when the posterior pelvis is treated surgically. When another intervention is needed in case of a recurrent ipsilateral or new contralateral sacral fracture, the cement may hinder iliosacral screw insertion.
Injuries of the pelvis
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
An AP radiograph of the pelvis (Figure 29.7) should be carefully inspected, systematically looking in each of the five zones of injury: The sacroiliac joint area is inspected for any diastasis or sacral fracture.The ilium is inspected for any fracture.The teardrop is inspected. This is a radiological feature which correlates to the non-articular floor of the acetabulum, and close inspection in this area will reveal any acetabular fracture.The obturator foramen is inspected for any fracture of the superior or inferior pubic ramus.The symphysis pubis is examined for any fracture or diastasis.
Sacral insufficiency fracture after lumbosacral decompression and fusion
Published in Baylor University Medical Center Proceedings, 2022
Brendan M. Holderread, Caleb P. Shin, Ishaq Y. Syed, Ioannis Avramis, James M. Rizkalla
Meredith et al4 recommended iliosacral fixation as prophylaxis when considering the risk of SIF, emphasizing the importance of pelvic incidence. (High pelvic incidence increases the risk of sacral fracture after lumbosacral fusion.) Buell et al7 recommended beginning management conservatively, with indications for revision surgery including pain refractory to nonoperative management, presence of a neurological deficit, nonunion with anterolisthesis, L5–S1 pseudoarthrosis, and misalignment of the spinopelvic axis. When considering surgical planning, the authors also recommended iliac screws. They stated that patients at increased risk of SIF identified preoperatively may receive prophylactic iliac screws at the initial surgery. Of the four operative cases in this series, none received prophylactic lumbopelvic fixation or iliac screws as part of salvage therapy. Two patients developed infection as a result of revision surgery and had complicated courses as a result. The two surgical cases without infection were managed with lumbopelvic fixation and returned to ambulate at their baseline. The patients managed nonoperatively with lumbar bracing, bone stimulator, or standard postoperative rehabilitation were all ambulating at their baseline with no symptoms within a year of their revision surgery.
Completion surgery after chemoradiotherapy for cervical cancer – is there a role? UK Cancer Centre experience of hysterectomy post chemo-radiotherapy treatment for cervical cancer
Published in Journal of Obstetrics and Gynaecology, 2019
Sarah L. Platt, Amit Patel, Pauline J. Humphrey, Hoda Al-Booz, Jo Bailey
Clinical notes were reviewed to assess for the medium and long-term post-treatment complications. Most of the patient-reported symptoms and side-effects were bowel and urinary problems. Of the 7/15 patients with bowel symptoms: three had chronic diarrhoea necessitating a regular anti-diarrhoeal medication, one had normal investigations following an episode of rectal bleeding, two had a radiation proctitis diagnosed at colonoscopy, and one had an entero-vesical fistula requiring a defunctioning ileostomy. This last patient also had a vesico-vaginal fistula requiring an ileal conduit at the same surgical intervention. Five other patients had urinary complications: one had a resolving urinary incontinence, two had a urinary urgency and a haematuria confirmed as radiation cystitis at cystoscopy, and two had a urological intervention for a ureteric fibrosis with retrograde stents in one case and nephrostomy in the other case. Three patients reported chronic pelvic and back pain symptoms, one secondary to a sacral fracture. Additionally, two patients reported anxiety and depression symptoms, whilst one patient reported an ongoing fatigue.
Risk factors, fractures, and management of pregnancy-associated osteoporosis: a retrospective study of 14 Turkish patients
Published in Gynecological Endocrinology, 2020
Filiz Tuna, Cansu Akleylek, Hande Özdemir, Derya Demirbağ Kabayel
Of the women in our study, 78.6% had fractures due to PAO. These fractures were mainly localized to the spine (75%) and median of the fractures were one. The thoracolumbar spine, particularly L1 and L2 (Figure 1), was the most common fracture site. As such, 60.6% of patients reported fractures in the thoracic area, 30.3% in the lumbar area, and 9.1% in the sacral area. The distribution of the 33 fractures was as follows: five in L1, three in L2, two in each T1 and T4–T12, one in each L3 and L4 vertebrae, and three as sacral fracture. Two patients only had sacral fracture, while one had both sacral fracture and vertebral fractures.