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Instructional Course Lectures 2009Sacral fractures are a treatment challenge for the orthopaedic surgeon. The relative rarity of sacral fractures limits physician exposure to these injuries and has...
Sacral fractures are a treatment challenge for the orthopaedic surgeon. The relative rarity of sacral fractures limits physician exposure to these injuries and has resulted in questions regarding their optimal treatment. Proper diagnosis and classification also are subjects of considerable debate. Studies of sacral fractures have been mainly retrospective in nature and have involved heterogeneous and small patient populations. The current literature is, therefore, limited.
Topics: Bone Screws; Decompression, Surgical; Humans; Sacrum; Spinal Fractures
PubMed: 19385574
DOI: No ID Found -
Neurosurgical Focus 2014Sacral fractures are uncommon lesions and most often the result of high-energy trauma. Depending on the fracture location, neurological injury may be present in over 50%... (Review)
Review
Sacral fractures are uncommon lesions and most often the result of high-energy trauma. Depending on the fracture location, neurological injury may be present in over 50% of cases. In this article, the authors conducted a comprehensive literature review on the epidemiology of sacral fractures, relevant anatomy of the sacral and pelvic region, common sacral injuries and fractures, classification systems of sacral fractures, and current management strategies. Due to the complex nature of these injuries, surgical management remains a challenge for the attending surgeon. Few large-scale studies have addressed postoperative complications or long-term results, but current evidence suggests that although fusion rates are high, long-term morbidity, such as residual pain and neurological deficits, persists for many patients.
Topics: Adult; Fracture Fixation, Internal; Humans; Male; Postoperative Complications; Sacrum; Spinal Fractures; Tomography, X-Ray Computed
PubMed: 24981900
DOI: 10.3171/2014.5.FOCUS1474 -
PloS One 2014Here we use the description of a new specimen of the small caseid synapsid Casea broilii that preserves the sacral, pelvic and hind limb regions in great detail and in... (Review)
Review
New postcranial material of the early caseid Casea broilii Williston, 1910 (Synapsida: Caseidae) with a review of the evolution of the sacrum in Paleozoic non-mammalian synapsids.
Here we use the description of a new specimen of the small caseid synapsid Casea broilii that preserves the sacral, pelvic and hind limb regions in great detail and in three dimensions, as a unique opportunity to reevaluate the early stages in the evolution of the sacrum in the lineage that led to mammals. We place this new material in the context of sacral evolution in early caseid synapsids and conclude that the transition from two to three sacral vertebrae occurred in small-bodied species, suggesting that it was not an adaptation to heavy weight bearing. Furthermore, we compare descriptions of sacral anatomy among known early synapsids, including caseids, ophiacodontids, edaphosaurids, varanopids, and sphenacodontians and review sacral evolution in early synapsids. Based on the descriptions of new species of caseids, edaphosaurids, and varanopids over the past several decades, it is clear that a sacrum consisting of three vertebrae evolved independently at least four times in synapsids during the Late Carboniferous and Early Permian. Furthermore, similarities in the morphologies of the sacral vertebrae and ribs of these early synapsids lead us to conclude that an anterior caudal vertebra had been incorporated into the sacral series convergently in these groups. Given the repeated acquisition of a three-vertebra sacrum in early synapsids and no apparent link to body size, we argue that this sacral anatomy was related to more efficient terrestrial locomotion than to increased weight bearing.
Topics: Animals; Biological Evolution; Body Weight; Chordata; Extremities; Fossils; Locomotion; Pelvic Bones; Sacrum; Spinal Cord
PubMed: 25545624
DOI: 10.1371/journal.pone.0115734 -
European Journal of Trauma and... Apr 2022We aim to report clinical and radiological results of triangular osteosynthesis for a homogenous group of vertically unstable transforaminal sacral fractures.
PURPOSE
We aim to report clinical and radiological results of triangular osteosynthesis for a homogenous group of vertically unstable transforaminal sacral fractures.
METHODS
Between 2013 and 2018, 22 consecutive patients with unstable sacral fractures were treated with triangular osteosynthesis consisting of iliosacral screw augmented by spinopelvic fixation. Patients were followed up prospectively as a single cohort. Bone union, complications, clinical and radiological outcomes were investigated.
RESULTS
Mean follow-up was 3.1 years (12-76 months). There was one bilateral fracture. Two patients underwent anterior plating for pubic symphyseal disruption. Based on Majeed and Iowa pelvic scores, 13 patients had excellent, seven had good and two had fair clinical outcome. All the patients could perform squatting, sitting cross-legged and kneeling without any restrictions. There were no additional neurological injuries. One patient had non-union of sacral fracture, one patient had deep infection, one patient had marginal wound necrosis and two patients complained of pain related to implant prominence. Two patients had connecting rod backout. All but one patient attained pre-operative work status.
CONCLUSION
Triangular osteosynthesis is a reliable procedure in treating unstable transforaminal sacral fractures. It permits early weight-bearing and facilitates faster functional recovery. Careful attention to details such as sacral dysmorphism, soft tissue injury, implant placement and anterior pelvic injury helps in keeping complications to an acceptable rate.
Topics: Bone Screws; Fracture Fixation, Internal; Fractures, Bone; Humans; Pelvic Bones; Radiography; Sacrum; Spinal Fractures; Treatment Outcome
PubMed: 34009417
DOI: 10.1007/s00068-021-01688-y -
Journal of Long-term Effects of Medical... 2022Sacroiliac screw fixation involves the use of cannulated, partially or fully threaded screws. Current partially threaded screws have standardized thread lengths...
Sacroiliac screw fixation involves the use of cannulated, partially or fully threaded screws. Current partially threaded screws have standardized thread lengths involving a small portion of the screw regardless of its overall length. Forty uninjured computed tomography images were evaluated for distances from the lateral iliac cortex to the lateral sacral cortex at the first and second sacral segments. No difference in measurements were observed for gender, age, or body mass index. Using a smooth segment value of 32 mm, a significant increase in thread lengths is achievable allowing for a novel sacroiliac screw design to achieve greater purchase in the sacrum.
Topics: Bone Screws; Fracture Fixation, Internal; Humans; Sacrum; Tomography, X-Ray Computed
PubMed: 35695621
DOI: 10.1615/JLongTermEffMedImplants.2021039485 -
Journal of Clinical Neuroscience :... Aug 2009The human sacrum is the target of lumbosacral instrumentation and decompression procedures. Such surgical interventions require detailed knowledge of the anatomy of the...
The human sacrum is the target of lumbosacral instrumentation and decompression procedures. Such surgical interventions require detailed knowledge of the anatomy of the human sacrum. The aim of this study was to measure surgically relevant parameters. Several factors, including the one-piece composition of the sacrum, the angles of the sacral pedicles and the anteroposterior diameter of the sacral vertebral bodies distinguish the sacrum from other parts of spine. Thirty-two measurements of shape, angles and distances between parts were taken of the sacra of 100 adult West Anatolian people using a Vernier caliper accurate to 0.1 mm and goniometer. According to this morphometric study, when measured from the sagittal, the S1 facet angle was measured as 35.71 degrees +/-9.59 and 34.70 degrees +/-9.66, the sacral pedicle anteromedial screw trajectory angle was 35.65 degrees +/-4.73 and 31.95 degrees +/-3.95 and the anterolaterally oriented sacral wing screw trajectory angle was 32.65 degrees +/-3.51 and 29.10 degrees +/-3.14, on the right and left sides, respectively. The distance of the midline oriented S1 pedicle screw was 51.12 mm and 51.26 mm on the right and left side, respectively. The distance for sacral wing oriented screw placement was 50.13 mm and 50.46 mm on the right and left side, respectively. The anteroposterior and transverse diameter of the sacral spinal canal were 21.81 mm and 31.31 mm, respectively. Thus, this study describes anatomical specifications of the sacrum. These defined morphometric details should be taken into consideration during surgical procedures. This study also describes anatomical landmarks which will allow injury of the sacrum during surgery to be avoided.
Topics: Bone Screws; Humans; Sacrum
PubMed: 19442524
DOI: 10.1016/j.jocn.2008.07.081 -
BMC Musculoskeletal Disorders Apr 2022The aneurysmal bone cyst (ABC) is a benign, but locally aggressive cystic lesion of the bone. It usually occurs in the metaphysis of long bones of adolescents and young...
BACKGROUND
The aneurysmal bone cyst (ABC) is a benign, but locally aggressive cystic lesion of the bone. It usually occurs in the metaphysis of long bones of adolescents and young adults but can also affect the pelvis.
METHODS
This single-center study is a retrospective review of 17 patients with primary ABCs of the pelvis. It examines the importance of polidocanol instillations as minimally invasive treatment option for ABCs of the pelvis compared to intralesional curettage or marginal resection.
RESULTS
Seventeen patients with the diagnosis of a primary ABC of the pelvis were included in the study. Six patients were male (35%) and 11 patients female (65%); the mean age was 18 (9-49) years. The mean follow-up time was 50 months (12-136 months). The most common location of manifestation was the pubis (6; 35%), followed by the ilium (6; 35%), the sacrum (3; 18%) and the ischium (2; 12%). Eight patients were treated by intralesional curettage with the use of adjuvants, one patient by marginal resection, seven by sequential instillation of polidocanol and one patient by simple observation. Five patients received an additional transarterial embolization. After intralesional curettage local recurrence was detected in 4/8 cases (50%). After instillation therapy six patients (86%) had a stable disease without recurrence, only one patient (14%) had a persistent disease with need of additional treatment and was therefore converted to intralesional curettage without local recurrence in the follow-up.
CONCLUSIONS
Sequential instillations of polidocanol are a promising, minimally invasive treatment method for ABCs of the pelvis and can be well combined with transarterial embolization.
Topics: Adolescent; Bone Cysts, Aneurysmal; Curettage; Female; Humans; Male; Pelvis; Polidocanol; Sacrum; Young Adult
PubMed: 35490224
DOI: 10.1186/s12891-022-05362-1 -
Radiographics : a Review Publication of... 2009
Topics: Aged; Chordoma; Humans; Magnetic Resonance Imaging; Male; Sacrum; Spinal Neoplasms; Tomography, X-Ray Computed
PubMed: 19755609
DOI: 10.1148/rg.295085215 -
Surgical and Radiologic Anatomy : SRA Dec 2005Degenerative disease and instability in the lower lumbar spine may necessitate fusion and stabilization supplemented by instrumentation to the sacrum. However, screw... (Comparative Study)
Comparative Study
Degenerative disease and instability in the lower lumbar spine may necessitate fusion and stabilization supplemented by instrumentation to the sacrum. However, screw placement in a reasonable position is more difficult to achieve because of the unique anatomy of the first sacral (S1) vertebra. Therefore, this study has been conducted to evaluate sacrum anatomy of the Western Anatolian population in terms of morphometric measurements and make a comparison with previous studies as well as giving a guidance to the surgeons. In this study, 60 dry adult sacrums (30 male and 30 female) were assessed for morphometric analysis. The measurement data for the sacrum and S1 vertebra revealed that there was no significant difference between both sexes except the sacral width and sacral canal width (p<0.05). In the present study, the ratio of S1 corpus' width to sacral width was lower in females compared with males. A detailed knowledge of the morphometric data about sacrum is very important for spinal surgery, as pedicle screw insertion is crucial in spinal instrumentation in order to prevent neurological injury and/or fixation failure.
Topics: Adult; Body Weights and Measures; Female; Humans; Male; Sacrum; Sex Factors; Spinal Canal
PubMed: 16211321
DOI: 10.1007/s00276-005-0036-1 -
Spine May 1998Radiographic and direct quantitative measurements were made of the cortical and the trabecular anatomy of the sacrum.
STUDY DESIGN
Radiographic and direct quantitative measurements were made of the cortical and the trabecular anatomy of the sacrum.
OBJECTIVES
To define the trabecular patterns and the cortical thickness of the sacrum.
SUMMARY OF BACKGROUND DATA
The sacrum is a frequent site of internal fixation. In previous anatomic studies, investigators have focused on specific dimensional measurements of the sacrum, whereas others have described the anatomic course of the anterior sacral neurovascular or visceral structures. Computed tomographic imaging also has been used to quantify the sacral trabecular bone density. The internal architecture of the sacrum has yet to be described in detail.
METHODS
Seventeen cadaveric sacra were studied by computed tomographic imaging and then were sectioned at 3-mm intervals in the axial or sagittal plane. The cortical thickness of each section was measured under microscopic visualization. The sections were radiographed with high-resolution imaging to delineate their trabecular patterns.
RESULTS
The trabecular bone was densest adjacent to the endplates. The sacral body trabeculae were arranged in a cruciate pattern, and bony atrophy occurred in a systematic fashion. An alar void was a consistent finding in all specimens with definable boundaries. The cortical thickness was uniform throughout the surface of each specimen. The computed tomographic images correlated with the anatomy observed in the cadaveric sections.
CONCLUSION
The internal bony architecture of the sacrum has several consistent features. The relatively uniform cortical thickness seen in each sacral specimen may have clinical significance in the internal fixation of this region.
Topics: Aged; Cadaver; Female; Humans; Male; Middle Aged; Sacrum; Tomography, X-Ray Computed
PubMed: 9589533
DOI: 10.1097/00007632-199805010-00001