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.
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Fountain SS, Hamilton RD, Jameson RM (1977) Transverse fractures of the sacrum: a report of 6 cases. J Bone Joint Surg Am 59:486–489
Denis F, Davis S, Comfort T (1988) Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res 227:67–81
Gibbons JK, Soloniuk DS, Razack N (1990) Neurological injury and pattern of sacral fractures. J Neurosurg 72:889–893
Kim MY, Reidy DP, Nolan PC, Finkelstein JA (2001) Transverse sacral fractures: case series and literature review. Can J Surg 44(5):359–363
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):342–346
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. 1031–1051
Bonin JG (1945) Sacral fractures and injuries to the cauda equine. J Bone Joint Surg Br 27:113–127
Schmidek HH, Smith DA, Kristiansen TK (1984) Sacral fractures. Neurosurgery 15:735–746
Sabiston CP, Wing PC (1986) Classification and neurologic implications. J Trauma 26:1113–1115
Roy-Camille R, Saillant G, Gagna G, Mazel C (1985) Transverse fracture of the upper sacrum. Suicide jumper’s fracture. Spine 10:838–845
Weaver EN, England GD, Richardson DE (1981) Sacral fracture: case presentation and review. Neurosurgery 9:725–728
Ferris B, Hutton P (1983) Anteriorly displaced transverse fracture of the sacrum at the level of the sacroiliac joint. J Bone Joint Surg Am 65:407–409
Novkov HV, Tanchev PJ, Gyorev IS (1996) Severe fracture-dislocation of S1 in a 12-year-old boy: a case report. Spine 21:2500–2503
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):969–971
Rodreigues-Fientes AE (1993) Traumatic sacrolisthesis S1–S2: report of a case. Spine 18:768–771
Jackson H, Kam J, harris JH Jr, Harle TS (1982) The sacral arcuate lines in upper sacral fractures. Radiology 145:35–39
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 194:195–198
Sapkas G, Pantazopoulos T, Efstathiou P (1985) Anteriorly displaced transverse fracture of the sacrum with fracture-dislocation at the L4–L5 lumbar level. Injury 16:353–357
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):951–953
Ikada K, Wada E, Kodama N (1991) Traction injury of the lumbosacral spinal nerve roots: report of a case. Spine 16:368–371
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):857–863
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 120:155–158
Dowling T, Epstein J, Epstein N (1985) S1–S2 sacral fracture involving neural elements of the cauda equine. Spine 10:851–853
Suzuki K, Mochida J (2001) Operative treatment of a transverse fracture-dislocation at the S1–S2 level. J Orthop Trauma 15(5):363–367
Hessmann MH, Rommens PM (2002) Transverse fracture-dislocation of the sacrum: a diagnostic pitfall and a surgical challenge. Acta Chir Belg 102(1):46–51
Latenser BA, Gentilello LM, Tarver AA, Thalgott JS, Batdorf JW (1991) Improved outcome with early fixation of skeletally unstable pelvic fracture. J Trauma 31:28–31
Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 70:1–12
Pohlemann T, Angst M, Schneider E, Ganz R, Tscherne H (1993) Fixation of transforaminal sacrum fractures: a biomechanical study. J Orthop Trauma 7:107–17
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 17:399–405
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Sapkas, G.S., Mavrogenis, A.F. & Papagelopoulos, P.J. Transverse sacral fractures with anterior displacement. Eur Spine J 17, 342–347 (2008). https://doi.org/10.1007/s00586-007-0528-2
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DOI: https://doi.org/10.1007/s00586-007-0528-2