Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Trauma - Spine
Abstract number: 26046
LUMBOSACRAL FRACTURE-DISLOCATION COMBINED WITH UNSTABLE
PELVIC RING INJURY. ONE-STAGE STABILIZATION PROCEDURE USING
SPINAL INSTRUMENTATION
GEORGIOS KARALIOTAS, Vasileios SAKELARIOU, Haridimos TSIBIDAKIS,
Konstantinos STARANTZIS, Panagiotis KONTOVAZENITIS, Konstantinos
SOULTANIS
A' Orthopaedic Department, Athens University Medical School, 'ATTIKON' University
Hospital, Athens (GREECE)
Introduction: Combined pelvic ring disruption with S1 fracture-olisthesis is
reported to be an extremely rare injury and challenging to treat. Purpose: To present
a patient with such injuries and the surgical treatment he underwent. Patient/Method:
A 19 year-old male sustained a motorcycle traffic accident. He presented at the
emergencies unconscious with open abdominal trauma and lower extremity
degloving injuries and underwent immediate exploration laparotomy and
sigmoeidostomy. Radiologic examination revealed bilateral pubic rami fractures , S1
fracture dislocation, and fracture of the right ischial tuberocity and sacral wing with
sacroiliac joint disruption. Orthopaedic intervention was decided when his general
condition stabilized. Posterior spinal instrumentation system was used with
transpedicular screws placed at L2, L3 and L4 vertebras and iliac crests (modified
Galveston technique). For the reduction and stabilization of the pelvic ring and the S1
olisthesis, spinal rods were implanted and secured on the transpedicular screws. L5
and S1 laminectomy was performed in order to decompress the dural sack and nerve
roots. Postoperative neurological status recorded severe right limb disability and loss
of bladder control. Physical therapy started postoperatively to mobilize the patient as
soon as possible. Result: 8 weeks postoperatively the patient was able to walk by
himself and his neurological status was markedly improved. Two years
postoperatively he has a minor axial low back pain, minor leg length discrepancy and
sexual dysfunction.Conclusion: Challenging combined lumbosacral and pelvic ring
traumatic instability can be effectively treated in an one-stage procedure through the
same posterior approach by using spinal instrumentation system.
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