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Mini-open Stabilization of a Sacral Fracture.
MedLine Citation:
PMID:  22895400     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: and Importance: Comminuted sacral fractures present significant challenges for operative management. Open and percutaneous sacroiliac screws have been used for stabilization but carry not insignificant rates of complications including wound infection for the former, and malposition and neurological injury for the latter. We report use of a novel mini-open lumbar-ilium fixation for stabilization of a patient with a comminuted sacral fracture. CLINICAL PRESENTATION:: A 33-year-old man with intact neurologic function was admitted following a fall of approximately 25 feet. A comminuted sacral fracture was diagnosed. The patient was unable to tolerate conservative management due to pain in upright positions. The patient was taken to the operating room for stabilization with a "mini-open" procedure involving L4 and L5 pedicle screws and bilateral iliac screws. Four two-inch paramedian incisions were made overlying the L4-L5 facet joints and medial to the sacroiliac joints. Minimally invasive retractors were placed to expose bony landmarks. L4-L5 pedicle screws and bilateral iliac screws were placed with minimal fluoroscopic guidance. Titanium rods were tunneled inferior-superiorly between incisions and affixed to screw heads. Total operative time was approximately 3.5 hours. The patient remained neurologically intact and had an uncomplicated recovery. One-year follow up CT showed successful healing of the sacrum. CONCLUSION:: We report the first case of a "mini-open" procedure to treat a comminuted sacral fracture. Use of this procedure offers a straightforward method for sacral stabilization with minimal blood loss and minimal radiation exposure. If indicated, this method could be combined with decompressive procedures.
Authors:
Jennifer Hong; William J Spire; Nathan E Simmons
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-14
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Division of Neurosurgery, Dartmouth Hitchcock Medical Center.
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