European Spine Journal

, Volume 17, Issue 3, pp 342–347 | Cite as

Transverse sacral fractures with anterior displacement

  • George S. Sapkas
  • Andreas F. Mavrogenis
  • Panayiotis J. Papagelopoulos
Original Article
First Online:
Received:
Revised:
Accepted:

Abstract

Transverse fractures of the sacrum with anterior displacement are the rarest type of transverse sacral fractures. They usually occur at the S1–S2 region in suicide jumpers. A clinical study was performed to evaluate the diagnosis, treatment and outcome of transverse sacral fractures with anterior displacement. We present six patients with a transverse fracture of the sacrum with anterior displacement. All patients presented with bowel and bladder dysfunction, perineal anesthesia, sensory and motor deficits at the lower extremities. Prompt diagnosis of the sacral fracture was obtained in five of the six patients. Operative treatment including lumbosacral laminectomies, spine instrumentation and fusion was done in all patients. Neurological recovery was almost complete in one patient, incomplete in four patients, and none in one patient. Although reduction of the fracture was not ideal in many of these patients, long-term clinical and radiographic follow-up, and neurological improvement were rewarding.

Keywords

Sacral fractures Transverse Anterior displacement 
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References

  1. 1.
    Fountain SS, Hamilton RD, Jameson RM (1977) Transverse fractures of the sacrum: a report of 6 cases. J Bone Joint Surg Am 59:486–489PubMedGoogle Scholar
  2. 2.
    Denis F, Davis S, Comfort T (1988) Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 227:67–81PubMedGoogle Scholar
  3. 3.
    Gibbons JK, Soloniuk DS, Razack N (1990) Neurological injury and pattern of sacral fractures. J Neurosurg 72:889–893PubMedCrossRefGoogle Scholar
  4. 4.
    Kim MY, Reidy DP, Nolan PC, Finkelstein JA (2001) Transverse sacral fractures: case series and literature review. Can J Surg 44(5):359–363PubMedGoogle Scholar
  5. 5.
    Sapkas G, Makris A, Korres D, Kyratzoulis J, Meleteas E, Antoniadis A (1997) Anteriorly displaced transverse fractures of the sacrum in adolescents: report of two cases. Eur Spine J 6(5):342–346PubMedCrossRefGoogle Scholar
  6. 6.
    Levine AM (2003) Fractures of the Sacrum. In: Browner BD, Jupiter JB, Levine AM, Trafton PG (eds) Skeletal trauma, 3rd edn. W.B. Saunders Company, Philadelphia, pp. 1031–1051Google Scholar
  7. 7.
    Bonin JG (1945) Sacral fractures and injuries to the cauda equine. J Bone Joint Surg Br 27:113–127Google Scholar
  8. 8.
    Schmidek HH, Smith DA, Kristiansen TK (1984) Sacral fractures. Neurosurgery 15:735–746PubMedCrossRefGoogle Scholar
  9. 9.
    Sabiston CP, Wing PC (1986) Classification and neurologic implications. J Trauma 26:1113–1115PubMedGoogle Scholar
  10. 10.
    Roy-Camille R, Saillant G, Gagna G, Mazel C (1985) Transverse fracture of the upper sacrum. Suicide jumper’s fracture. Spine 10:838–845PubMedCrossRefGoogle Scholar
  11. 11.
    Weaver EN, England GD, Richardson DE (1981) Sacral fracture: case presentation and review. Neurosurgery 9:725–728PubMedCrossRefGoogle Scholar
  12. 12.
    Ferris B, Hutton P (1983) Anteriorly displaced transverse fracture of the sacrum at the level of the sacroiliac joint. J Bone Joint Surg Am 65:407–409PubMedGoogle Scholar
  13. 13.
    Novkov HV, Tanchev PJ, Gyorev IS (1996) Severe fracture-dislocation of S1 in a 12-year-old boy: a case report. Spine 21:2500–2503PubMedCrossRefGoogle Scholar
  14. 14.
    Phelan ST, Jones DA, Bishay M (1991) Conservative management of transverse fractures of the sacrum with neurological features. A report of four cases. J Bone Joint Surg Br 73(6):969–971PubMedGoogle Scholar
  15. 15.
    Rodreigues-Fientes AE (1993) Traumatic sacrolisthesis S1–S2: report of a case. Spine 18:768–771CrossRefGoogle Scholar
  16. 16.
    Jackson H, Kam J, harris JH Jr, Harle TS (1982) The sacral arcuate lines in upper sacral fractures. Radiology 145:35–39PubMedGoogle Scholar
  17. 17.
    Carl A, Delman A, Engler G (1985) Displaced transverse sacral fractures. A case report, review of the literature, and the CT scan as an aid in management. Clin Orthop Relat Res 194:195–198PubMedGoogle Scholar
  18. 18.
    Sapkas G, Pantazopoulos T, Efstathiou P (1985) Anteriorly displaced transverse fracture of the sacrum with fracture-dislocation at the L4–L5 lumbar level. Injury 16:353–357CrossRefGoogle Scholar
  19. 19.
    Karray M, Rajhi H, Kouki S, Mnif N, Bouzidi R, Zlitni M, Hamza R (2005) Transverse fracture of the sacrum: value of imaging. A case report. J Radiol 86(7–8):951–953PubMedGoogle Scholar
  20. 20.
    Ikada K, Wada E, Kodama N (1991) Traction injury of the lumbosacral spinal nerve roots: report of a case. Spine 16:368–371CrossRefGoogle Scholar
  21. 21.
    Mouhsine E, Wettstein M, Schizas C, Borens O, Blanc CH, Leyvraz PF, Theumann N, Garofalo R (2006) Modified triangular posterior osteosynthesis of unstable sacrum fracture. Eur Spine J 15(6):857–863PubMedCrossRefGoogle Scholar
  22. 22.
    Fardon DF (1976) Displaced transverse fractures of the lumbo-sacral spine with delayed cauda equine deficit: report of a case and review of literature. Clin Orthop Relat Res 120:155–158PubMedGoogle Scholar
  23. 23.
    Dowling T, Epstein J, Epstein N (1985) S1–S2 sacral fracture involving neural elements of the cauda equine. Spine 10:851–853PubMedCrossRefGoogle Scholar
  24. 24.
    Suzuki K, Mochida J (2001) Operative treatment of a transverse fracture-dislocation at the S1–S2 level. J Orthop Trauma 15(5):363–367PubMedCrossRefGoogle Scholar
  25. 25.
    Hessmann MH, Rommens PM (2002) Transverse fracture-dislocation of the sacrum: a diagnostic pitfall and a surgical challenge. Acta Chir Belg 102(1):46–51PubMedGoogle Scholar
  26. 26.
    Latenser BA, Gentilello LM, Tarver AA, Thalgott JS, Batdorf JW (1991) Improved outcome with early fixation of skeletally unstable pelvic fracture. J Trauma 31:28–31PubMedGoogle Scholar
  27. 27.
    Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 70:1–12PubMedGoogle Scholar
  28. 28.
    Pohlemann T, Angst M, Schneider E, Ganz R, Tscherne H (1993) Fixation of transforaminal sacrum fractures: a biomechanical study. J Orthop Trauma 7:107–17PubMedCrossRefGoogle Scholar
  29. 29.
    Griffin DR, Starr AJ, Reinert CM, Jones AL, Whitlock S (2003) Vertically unstable pelvic fractures fixed with percutaneous iliosacral screws: does posterior injury pattern predict fixation failure? J Orthop Trauma 17:399–405PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • George S. Sapkas
    • 1
  • Andreas F. Mavrogenis
    • 1
  • Panayiotis J. Papagelopoulos
    • 1
  1. 1.First Department of OrthopaedicsAthens University Medical SchoolAthensGreece

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