Skip to main content
SpringerLink
Log in

Management of traumatic spinopelvic dissociations: review of the literature

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Spinopelvic dissociation is a rare high-energy injury pattern in adults associated with high morbidity and an increased rate of neurological deficits. The purpose of this article is the conception of fracture type-associated treatment recommendations.

Methods

This article is based on our own experience with spinopelvic dissociations and a review of the current literature.

Results

Bilateral vertical plus an optional transverse fracture component configures spinopelvic dissociations as “U”- or “H”-shaped, with the result of a spinopelvic dissociation. “Y”-, “T”- or “II”-shaped fractures do not necessarily belong to this entity but can be subsumed to this entity in a wider sense. The surgical treatment of these injuries remains challenging. Initial haemodynamic stabilisation represents the main goal of primary care until definitive treatment can be performed. Anatomical reduction is demanding and even more complex in fracture areas with large comminution. Surgical treatment options depend on the fracture type, including transsacral screws, sacral banding and spinopelvic fixation, plus combinations of these procedures.

Conclusions

Spinopelvic dissociations remain highly complex injuries. “U”- and “H”-shaped fractures usually require triangular fixation, whereas “II”-, “Y”- and “T”-shaped fractures might be sufficiently stabilised with transsacral screws.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Roy-Camille R, Saillant G, Gagna G, Mazel C. Transverse fracture of the upper sacrum. Suicidal jumper’s fracture. Spine (Phila Pa 1976). 1985;10:838–45.

    Article  CAS  Google Scholar 

  2. König MA, Jehan S, Boszczyk AA, Boszczyk BM. Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies. Eur Spine J. 2011;20(12):2252–60.

    Google Scholar 

  3. Bents RT, France JC, Glover JM, Kaylor KL. Traumatic spondylopelvic dissociation. A case report and literature review. Spine (Phila Pa 1976). 1996;21:1814–19.

    Article  CAS  Google Scholar 

  4. Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988;227:67–81.

    PubMed  CAS  Google Scholar 

  5. Strange-Vognsen HH, Lebech A. An unusual type of fracture in the upper sacrum. J Orthop Trauma. 1991;5:200–3.

    Article  PubMed  CAS  Google Scholar 

  6. Yi C, Hak DJ. Traumatic spinopelvic dissociation or U-shaped sacral fracture: a review of the literature. Injury. 2012;43(4):402–408.

    Article  PubMed  Google Scholar 

  7. Huber-Wagner S, Lefering R, Qvick LM, Körner M, Kay MV, Pfeifer KJ, Reiser M, Mutschler W, Kanz KG; Working Group on Polytrauma of the German Trauma Society. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009;373:1455–61.

    Article  PubMed  Google Scholar 

  8. Kellam JF, McMurtry RY, Paley D, Tile M. The unstable pelvic fracture. Operative treatment. Orthop Clin North Am. 1987;18:25–41.

    PubMed  CAS  Google Scholar 

  9. Knops SP, Schep NW, Spoor CW, van Riel MP, Spanjersberg WR, Kleinrensink GJ, van Lieshout EM, Patka P, Schipper IB. Comparison of three different pelvic circumferential compression devices: a biomechanical cadaver study. J Bone Joint Surg Am. 2011;93:230–40.

    Article  PubMed  CAS  Google Scholar 

  10. Lustenberger T, Meier C, Benninger E, Lenzlinger PM, Keel MJ. C-clamp and pelvic packing for control of hemorrhage in patients with pelvic ring disruption. J Emerg Trauma Shock. 2011;4:477–82.

    PubMed  Google Scholar 

  11. Böhme J, Lägel A, Schmidt F, Tiemann AH, Josten C. Ligament healing results after type C pelvic ring fractures. results of triangular vertebropelvic support. Unfallchirurg. 2010;113:734–40.

    Article  PubMed  Google Scholar 

  12. Henes FO, Nüchtern JV, Groth M, Habermann CR, Regier M, Rueger JM, Adam G, Grossterlinden LG. Comparison of diagnostic accuracy of magnetic resonance Imaging and multidetector computed tomography in the detection of pelvic fractures. Eur J Radiol. 2012;81:2337–2342.

    Article  PubMed  CAS  Google Scholar 

  13. Steiner CL, Trentz O, Labler L. Management of Morel-Lavallee lesion associated with pelvic and/or acetabular fractures. Eur J Trauma Emerg Surg. 2008;34:554–60.

    Article  Google Scholar 

  14. Rhee WT, You SH, Jang YG, Lee SY. Lumbo-sacro-pelvic fixation using iliac screws for the complex lumbo-sacral fractures. J Korean Neurosurg Soc. 2007;42:495–8.

    Article  PubMed  Google Scholar 

  15. Hussin P, Chan CY, Saw LB, Kwan MK. U-shaped sacral fracture: an easily missed fracture with high morbidity. A report of two cases. Emerg Med J. 2009;26:677–8.

    Article  PubMed  CAS  Google Scholar 

  16. Vilela MD, Gelfenbeyn M, Bellabarba C. U-shaped sacral fracture and lumbosacral dislocation as a result of a shotgun injury: case report. Neurosurgery. 2009;64:E193–4.

    Article  PubMed  Google Scholar 

  17. Hunt N, Jennings A, Smith M. Current management of U-shaped sacral fractures or spino-pelvic dissociation. Injury. 2002;33:123–6.

    Article  PubMed  Google Scholar 

  18. Mouhsine E, Wettstein M, Schizas C, Borens O, Blanc CH, Leyvraz PF, Theumann N, Garofalo R. Modified triangular posterior osteosynthesis of unstable sacrum fracture. Eur Spine J. 2006;15:857–63.

    Article  PubMed  CAS  Google Scholar 

  19. Schildhauer TA, Bellabarba C, Nork SE, Barei DP, Routt ML Jr, Chapman JR. Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation. J Orthop Trauma. 2006;20:447–57.

    Article  PubMed  Google Scholar 

  20. 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. J Orthop Trauma. 2001;15:238–46.

    Article  PubMed  CAS  Google Scholar 

  21. Gribnau AJ, van Hensbroek PB, Haverlag R, Ponsen KJ, Been HD, Goslings JC. U-shaped sacral fractures: surgical treatment and quality of life. Injury. 2009;40:1040–8.

    Article  PubMed  CAS  Google Scholar 

  22. Taguchi T, Kawai S, Kaneko K, Yugue D. Operative management of displaced fractures of the sacrum. J Orthop Sci. 1999;4:347–52.

    Article  PubMed  CAS  Google Scholar 

  23. Sabourin M, Lazennec JY, Catonne Y, Pascal-Moussellard H, Rousseau MA. Shortening osteotomy and sacro-sacral fixation for U-shaped sacral fractures. J Spinal Disord Tech. 2010;23:457–60.

    Article  PubMed  Google Scholar 

  24. Vallier HA, Cureton BA, Ekstein C, Oldenburg FP, Wilber JH. Early definitive stabilization of unstable pelvis and acetabulum fractures reduces morbidity. J Trauma. 2010;69:677–84.

    Article  PubMed  Google Scholar 

  25. Katsoulis E, Giannoudis PV. Impact of timing of pelvic fixation on functional outcome. Injury. 2006;37:1133–42.

    Article  PubMed  Google Scholar 

  26. Käch K, Trentz O. Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis. Unfallchirurg. 1994;97:28–38.

    PubMed  Google Scholar 

  27. Josten C, Schildhauer TA, Muhr G. Therapy of unstable sacrum fractures in pelvic ring. Results of osteosynthesis with early mobilization. Chirurg. 1994;65:970–5.

    PubMed  CAS  Google Scholar 

  28. Schildhauer TA, Ledoux WR, Chapman JR, Henley MB, Tencer AF, Routt ML Jr. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma. 2003;17:22–31.

    Article  PubMed  Google Scholar 

  29. Schildhauer TA, Josten C, Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma. 2006;20:S44–51.

    PubMed  CAS  Google Scholar 

  30. Culemann U, Seelig M, Lange U, Gänsslen A, Tosounidis G, Pohlemann T. Biomechanical comparison of different stabilisation devices for transforaminal sacral fracture. Is an interlocking device advantageous? Unfallchirurg. 2007;110:528–36.

    Article  PubMed  CAS  Google Scholar 

  31. Gänsslen A, Pape HC, Lehmann U, Lange U, Krettek C, Pohlemann T. Open reduction and internal fixation of unstable sacral fractures. Zentralbl Chir. 2003;128:40–5.

    Article  PubMed  Google Scholar 

  32. Pohlemann T, Angst M, Schneider E, Ganz R, Tscherne H. Fixation of transforaminal sacrum fractures: a biomechanical study. J Orthop Trauma. 1993;7:107–17.

    Article  PubMed  CAS  Google Scholar 

  33. Keel MJ, Benneker LM, Siebenrock KA, Bastian JD. Less invasive lumbopelvic stabilization of posterior pelvic ring instability: technique and preliminary results. J Trauma. 2011;71:E62–70.

    Article  PubMed  Google Scholar 

  34. König MA, Seidel U, Heini P, Orler R, Quraishi NA, Boszczyk AA, Boszczyk BM. Minimal-invasive percutaneous reduction and transsacral screw fixation for U-shaped fractures. J Spinal Disord Tech. 2011.

  35. Pohlemann T, Gänsslen A, Tscherne H. Fracture of the sacrum. Unfallchirurg. 2000;103:769–86.

    Article  PubMed  CAS  Google Scholar 

  36. Schildhauer TA, Josten C, Muhr G. Die trianguläre Osteosynthese instabiler Sakrumfrakturen. Operat Orthop Traumatol. 2001;13:27–42.

    Article  Google Scholar 

  37. Vilela MD, Jermani C, Braga BP. Lumbopelvic fixation and sacral decompression for a U-shaped sacral fracture: case report. Arq Neuropsiquiatr. 2007;65:865–8.

    Article  PubMed  Google Scholar 

  38. Gibbons KJ, Soloniuk DS, Razack N. Neurological injury and patterns of sacral fractures. J Neurosurg. 1990;72:889–93.

    Article  PubMed  CAS  Google Scholar 

  39. Borg T, Holstad M, Larsson S. Quality of life in patients operated for pelvic fractures caused by suicide attempt by jumping. Scand J Surg. 2010;99:180–6.

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    W. Lehmann, M. Hoffmann, D. Briem, L. Grossterlinden, J. P. Petersen, M. Priemel, P. Pogoda, A. Ruecker & J. M. Rueger

Authors
  1. W. Lehmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Briem
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Grossterlinden
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. P. Petersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Priemel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Pogoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Ruecker
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J. M. Rueger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. Lehmann.

Additional information

This work is dedicated to the 60th anniversary of our mentor and surgical teacher, Prof. Dr. Med. Johannes M. Rueger, to whom we faithfully congratulate.

W. Lehmann and M. Hoffmann contributed equally to this manuscript and, therefore, share the first authorship.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lehmann, W., Hoffmann, M., Briem, D. et al. Management of traumatic spinopelvic dissociations: review of the literature. Eur J Trauma Emerg Surg 38, 517–524 (2012). https://doi.org/10.1007/s00068-012-0225-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-012-0225-7

Keyword

Search

Navigation