AS 1668.1 PDF

One patient died 2 days after the accident due to pulmonary embolism. Posterior lumbar-iliac fixation was performed as definitive surgical treatment in two cases Fig. A case of external fixation was associated with a posterior lumbar-iliac fixation. One patient refused second-look surgery and he was treated only with external fixation. Patients were rehabilitated early through passive mobilization and active assisted exercise of the lower limbs; they were then progressively discharged to an intensive neurorehabilitation center. The authors believe this excellent radiographic and functional result was due to the minimal displacement of the fracture which, with well-timed care, permitted healing, and neurologic recovery without complications.

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One patient died 2 days after the accident due to pulmonary embolism. Posterior lumbar-iliac fixation was performed as definitive surgical treatment in two cases Fig. A case of external fixation was associated with a posterior lumbar-iliac fixation. One patient refused second-look surgery and he was treated only with external fixation.

Patients were rehabilitated early through passive mobilization and active assisted exercise of the lower limbs; they were then progressively discharged to an intensive neurorehabilitation center. The authors believe this excellent radiographic and functional result was due to the minimal displacement of the fracture which, with well-timed care, permitted healing, and neurologic recovery without complications.

The other two patients did not show any sign of healing of the neurologic deficit in the last follow-up. In these cases, indeed, complexity and displacement of fractures were so important that the authors presume a severe radicular lesion, which compromised neurologic healing.

No cases of symptomatic protrusion of iliac screws or implant breakage were recorded. Thus, this kind of injury should always be investigated in cases of falls from high height, with pelvic and sacral pain, lumbosacral hematoma Morel-Lavelle lesion , sphincter deficit, or other neurologic lesions [ 8 ]. Pelvic and sacral radiographs in lateral view and CT scan are mandatory. The severity of neurologic lesion depends on the complexity and displacement of the sacral fracture. Vaccaro et al.

Surgical recommendations and the timing of decompression are still questionable. The literature suggests that spinopelvic fixation represents the best surgical treatment of these lesions. In , Kach and Trentz first proposed an open-surgery approach to reduce and stabilize the lumbar spine and pelvis with pedicle and ilium-sacrum screws or posterior transilium plates , which are linked with bars or cross-linked [ 7 , 10 ].

This technique allows equal distribution of forces to the acetabulum and lumbar spine, leaving out the fracture area and permits the early mobilization of the patient [ 10 ]. The correct placement of the iliac screws is evaluated through an intraoperative fluoroscopic Judet view of the pelvis [ 10 ]. The fixation of further fractures of the anterior pelvis, if necessary, can be performed subsequently. However, in polytraumatized patients, the concurrent severe neurologic damage does not always allow performance of early surgery [ 8 , 10 ].

Therefore, nerve decompression should be done both indirectly, with reduction of the fracture, and directly, through laminectomy or partial foraminectomy with lumboiliac fixation [ 8 , 10 ].

Yi and Hak stated that late decompression could be hard, because of fibrous scar tissue, and it could worsen the neurologic deficit [ 10 ]. Moreover, Schildhauer et al. Schildhauer et al. Conclusions Early diagnosis and treatment of spinopelvic dissociation are crucial for a proper management of severe associated lesions and they can lead to a better recovery of neurologic deficit and better quality of life. During the diagnostic process, when there is suspicion of this injury, proper radiographic assessment and CT scans are mandatory.

References 1. Zinghi GF, Pascarella R. Anello pelvico. Lesioni traumatiche. ISBN: Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation.

J Orthop Trauma.

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