Sacral Fracture

10
Pelvis Case #9

Transcript of Sacral Fracture

Pelvis Case #9

43 yo female p/w lower back pain s/p fall in ice skating rink 2 hours PTA.

No other complaints

History and PhysicalT 98.0 P 107 BP

147/83 O2 99%Gen: WDWN, mild

acute distressCV: Tachycardic, RR,

no m/r/gPulm: Lungs CTA bilatBack: PTTP lower

lumbar/sacral regionExt: Left foot drop

with L5 distribution paresis

Image

Diagnosis: Sacral Fracture

Stable fx:Outpt Orthopedic f/u in 1-2 wks

Unstable fx:Emergent Orthopedic c/s

Neurological DeficitEmergent Orthopedic c/s

ED Management

Follow 3 arcuate lines (foramen)Disruption= significant pathology

L5 TP frx without illiac crest frx, suggest occult sacral frx

StabilityStable:

impacted vertical fracture of sacrum, nondisplaced fracture of posterior sacroiliac complex; or subtle fracture of upper sacrum as seen by

Unstable:diastasis of more than 0.5 to 1 cm, along w/ an

unstable anterior injury

Pearls

Type 1frx at sacral ala L5 nerve root; ~6% with

neurological injuriesType 2

Frx at neuroforamina unilateral sacral anesthesia; Tx: operative debridement of frx fragments prior to

reduction

Type 3frx thru body cauda equina + neurogenic bladder;

~56% with neurological injuries

Pearls

Perform DREFor S1 nerve root involvementif bloody Open sacral fracture

Fractures a/w:Anterior pelvic frxThorough neuro exam

Pearls

Additional Images

R Sakakibara1, T Uchiyama1, C Yamaguchi2, et al. Spinal Cord (2007) 45, 790–792; doi:10.1038/sj.sc.3102058; published online 27 March 2007

http://www.imageinterpretation.co.uk/pelvis.html

http://www.wheelessonline.com/ortho/sacrum_and_sacral_fractures

Simon, Robert, and Scott Sherman. Emergency Orthopedics. New York: McGraw Hill, 2011. 6th Ed.

References