Giuseppe Emmanuele Umana1, Marco Teli2, Bipin Chaurasia3, Maurizio Passanisi1, Gianfranco Longo4, Angelo Spitaleri1, Marco Fricia1, Santino Ottavio Tomasi5, Giancarlo Ponzo6, Giovanni Federico Nicoletti6, Salvatore Cicero1, Massimiliano Visocchi7, Gianluca Scalia6. 1. Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy. 2. Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, England, UK. 3. Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal. 4. Department of Orthopedic Surgery, Trauma Center, Cannizzaro Hospital, Catania, Italy. 5. Department of Neurosurgery, Christian-Doppler-Klinik, Paracelsus Private Medical University, Salzburg, Austria. 6. Neurosurgery Unit, Highly Specialized Hospital and of National Importance "Garibaldi," Catania, Italy. 7. Master CVJ Surgical Approach Research Center, Craniovertebral Junction Operative Unit, Institute of Neurosurgery, Policlinic "A. Gemelli," Catholic University, Rome, Italy.
Abstract
BACKGROUND: Roy-Camille reported only three patients in their Type 3 posttraumatic transverse sacral fracture (TSF) classification. A modified Roy-Camille classification has been already proposed by other authors suggesting further categorization of the TSFs as partially displaced or completely displaced to predict the rate of neurological recovery following lumbopelvic fixation. MATERIALS AND METHODS: We reported three adult cases of surgical fixation of fracture-dislocation (3A and 3B) of the sacrum due to traumatic injuries and submitted to lumbopelvic posterior reconstruction. A case of a 15-year-old male patient affected by Type 3C with vascular pelvic injury was also reported. A comprehensive literature search was performed on evaluation and management of Type 3 TSFs. RESULTS: In Type 3A, there is a minimal anterior dislocation and the reduction is feasible with good chance of recovery. In Type 3B, the anterior dislocation is severe, neurological deficits are present, reduction is difficult, and there is a risk of vascular injury both at the trauma and during the surgical reduction. In Type 3C, the anterior dislocation is massive, and the risk of vascular injury is very high requiring prompt vascular or endovascular treatment. Open reduction and posterior instrumentation are technically feasible in patients affected by Type 3 high TSFs. CONCLUSIONS: In our opinion, a modified Roy-Camille classification could be useful in the assessment of prognostic and therapeutic aspects of such fractures, In our opinion, a modified Roy-Camille classification could help assess the prognostic and therapeutic aspects of such fractures, in which the severity of the dislocation affects the surgical technique, the chance of neurological recovery, and the patient's life expectancy. Copyright:
BACKGROUND: Roy-Camille reported only three patients in their Type 3 posttraumatic transverse sacral fracture (TSF) classification. A modified Roy-Camille classification has been already proposed by other authors suggesting further categorization of the TSFs as partially displaced or completely displaced to predict the rate of neurological recovery following lumbopelvic fixation. MATERIALS AND METHODS: We reported three adult cases of surgical fixation of fracture-dislocation (3A and 3B) of the sacrum due to traumatic injuries and submitted to lumbopelvic posterior reconstruction. A case of a 15-year-old male patient affected by Type 3C with vascular pelvic injury was also reported. A comprehensive literature search was performed on evaluation and management of Type 3 TSFs. RESULTS: In Type 3A, there is a minimal anterior dislocation and the reduction is feasible with good chance of recovery. In Type 3B, the anterior dislocation is severe, neurological deficits are present, reduction is difficult, and there is a risk of vascular injury both at the trauma and during the surgical reduction. In Type 3C, the anterior dislocation is massive, and the risk of vascular injury is very high requiring prompt vascular or endovascular treatment. Open reduction and posterior instrumentation are technically feasible in patients affected by Type 3 high TSFs. CONCLUSIONS: In our opinion, a modified Roy-Camille classification could be useful in the assessment of prognostic and therapeutic aspects of such fractures, In our opinion, a modified Roy-Camille classification could help assess the prognostic and therapeutic aspects of such fractures, in which the severity of the dislocation affects the surgical technique, the chance of neurological recovery, and the patient's life expectancy. Copyright:
Authors: Thomas A Schildhauer; Carlo Bellabarba; Sean E Nork; David P Barei; Milton L Chip Routt; Jens R Chapman Journal: J Orthop Trauma Date: 2006-07 Impact factor: 2.512