J A Finkelstein1, R W Hu, T al-Harby. 1. Division of Orthopaedics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Abstract
STUDY DESIGN: A patient with open posterior dislocation of the lumbosacral junction is reported. OBJECTIVES: Treatment with primary anterior open reduction with internal fixation followed by delayed posterior stabilization and fusion. SUMMARY OF BACKGROUND DATA: This injury has been reported previously on two occasions; however, anterior stabilization was not used. In this case, anterior fixation was necessary because of the posterior soft tissue contamination. METHODS: After an anterior open reduction of L5-S1, stabilization was performed using instrumentation. Posterior wound care was then performed, with delayed posterior fusion and instrumentation of L5-S1 at 2 weeks. RESULTS: At 18 months there was solid fusion of the lumbosacral junction with no evidence of infection. CONCLUSIONS: Satisfactory results were obtained when principles of open fracture management were followed. Primary anterior stabilization allowed appropriate wound care. Definitive posterior stabilization and fusion can be done when soft tissue stability is obtained.
STUDY DESIGN: A patient with open posterior dislocation of the lumbosacral junction is reported. OBJECTIVES: Treatment with primary anterior open reduction with internal fixation followed by delayed posterior stabilization and fusion. SUMMARY OF BACKGROUND DATA: This injury has been reported previously on two occasions; however, anterior stabilization was not used. In this case, anterior fixation was necessary because of the posterior soft tissue contamination. METHODS: After an anterior open reduction of L5-S1, stabilization was performed using instrumentation. Posterior wound care was then performed, with delayed posterior fusion and instrumentation of L5-S1 at 2 weeks. RESULTS: At 18 months there was solid fusion of the lumbosacral junction with no evidence of infection. CONCLUSIONS: Satisfactory results were obtained when principles of open fracture management were followed. Primary anterior stabilization allowed appropriate wound care. Definitive posterior stabilization and fusion can be done when soft tissue stability is obtained.