Skip to main content
Erschienen in: European Journal of Trauma and Emergency Surgery 5/2012

01.10.2012 | Original Article

Management of traumatic spinopelvic dissociations: review of the literature

verfasst von: W. Lehmann, M. Hoffmann, D. Briem, L. Grossterlinden, J. P. Petersen, M. Priemel, P. Pogoda, A. Ruecker, J. M. Rueger

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 5/2012

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Spinopelvic dissociation is a rare high-energy injury pattern in adults associated with high morbidity and an increased rate of neurological deficits. The purpose of this article is the conception of fracture type-associated treatment recommendations.

Methods

This article is based on our own experience with spinopelvic dissociations and a review of the current literature.

Results

Bilateral vertical plus an optional transverse fracture component configures spinopelvic dissociations as “U”- or “H”-shaped, with the result of a spinopelvic dissociation. “Y”-, “T”- or “II”-shaped fractures do not necessarily belong to this entity but can be subsumed to this entity in a wider sense. The surgical treatment of these injuries remains challenging. Initial haemodynamic stabilisation represents the main goal of primary care until definitive treatment can be performed. Anatomical reduction is demanding and even more complex in fracture areas with large comminution. Surgical treatment options depend on the fracture type, including transsacral screws, sacral banding and spinopelvic fixation, plus combinations of these procedures.

Conclusions

Spinopelvic dissociations remain highly complex injuries. “U”- and “H”-shaped fractures usually require triangular fixation, whereas “II”-, “Y”- and “T”-shaped fractures might be sufficiently stabilised with transsacral screws.
Literatur
1.
Zurück zum Zitat Roy-Camille R, Saillant G, Gagna G, Mazel C. Transverse fracture of the upper sacrum. Suicidal jumper’s fracture. Spine (Phila Pa 1976). 1985;10:838–45.CrossRef Roy-Camille R, Saillant G, Gagna G, Mazel C. Transverse fracture of the upper sacrum. Suicidal jumper’s fracture. Spine (Phila Pa 1976). 1985;10:838–45.CrossRef
2.
Zurück zum Zitat König MA, Jehan S, Boszczyk AA, Boszczyk BM. Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies. Eur Spine J. 2011;20(12):2252–60. König MA, Jehan S, Boszczyk AA, Boszczyk BM. Surgical management of U-shaped sacral fractures: a systematic review of current treatment strategies. Eur Spine J. 2011;20(12):2252–60.
3.
Zurück zum Zitat Bents RT, France JC, Glover JM, Kaylor KL. Traumatic spondylopelvic dissociation. A case report and literature review. Spine (Phila Pa 1976). 1996;21:1814–19.CrossRef Bents RT, France JC, Glover JM, Kaylor KL. Traumatic spondylopelvic dissociation. A case report and literature review. Spine (Phila Pa 1976). 1996;21:1814–19.CrossRef
4.
Zurück zum Zitat Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988;227:67–81.PubMed Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988;227:67–81.PubMed
5.
Zurück zum Zitat Strange-Vognsen HH, Lebech A. An unusual type of fracture in the upper sacrum. J Orthop Trauma. 1991;5:200–3.PubMedCrossRef Strange-Vognsen HH, Lebech A. An unusual type of fracture in the upper sacrum. J Orthop Trauma. 1991;5:200–3.PubMedCrossRef
6.
Zurück zum Zitat Yi C, Hak DJ. Traumatic spinopelvic dissociation or U-shaped sacral fracture: a review of the literature. Injury. 2012;43(4):402–408.PubMedCrossRef Yi C, Hak DJ. Traumatic spinopelvic dissociation or U-shaped sacral fracture: a review of the literature. Injury. 2012;43(4):402–408.PubMedCrossRef
7.
Zurück zum Zitat Huber-Wagner S, Lefering R, Qvick LM, Körner M, Kay MV, Pfeifer KJ, Reiser M, Mutschler W, Kanz KG; Working Group on Polytrauma of the German Trauma Society. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009;373:1455–61.PubMedCrossRef Huber-Wagner S, Lefering R, Qvick LM, Körner M, Kay MV, Pfeifer KJ, Reiser M, Mutschler W, Kanz KG; Working Group on Polytrauma of the German Trauma Society. Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet. 2009;373:1455–61.PubMedCrossRef
8.
Zurück zum Zitat Kellam JF, McMurtry RY, Paley D, Tile M. The unstable pelvic fracture. Operative treatment. Orthop Clin North Am. 1987;18:25–41.PubMed Kellam JF, McMurtry RY, Paley D, Tile M. The unstable pelvic fracture. Operative treatment. Orthop Clin North Am. 1987;18:25–41.PubMed
9.
Zurück zum Zitat Knops SP, Schep NW, Spoor CW, van Riel MP, Spanjersberg WR, Kleinrensink GJ, van Lieshout EM, Patka P, Schipper IB. Comparison of three different pelvic circumferential compression devices: a biomechanical cadaver study. J Bone Joint Surg Am. 2011;93:230–40.PubMedCrossRef Knops SP, Schep NW, Spoor CW, van Riel MP, Spanjersberg WR, Kleinrensink GJ, van Lieshout EM, Patka P, Schipper IB. Comparison of three different pelvic circumferential compression devices: a biomechanical cadaver study. J Bone Joint Surg Am. 2011;93:230–40.PubMedCrossRef
10.
Zurück zum Zitat Lustenberger T, Meier C, Benninger E, Lenzlinger PM, Keel MJ. C-clamp and pelvic packing for control of hemorrhage in patients with pelvic ring disruption. J Emerg Trauma Shock. 2011;4:477–82.PubMed Lustenberger T, Meier C, Benninger E, Lenzlinger PM, Keel MJ. C-clamp and pelvic packing for control of hemorrhage in patients with pelvic ring disruption. J Emerg Trauma Shock. 2011;4:477–82.PubMed
11.
Zurück zum Zitat Böhme J, Lägel A, Schmidt F, Tiemann AH, Josten C. Ligament healing results after type C pelvic ring fractures. results of triangular vertebropelvic support. Unfallchirurg. 2010;113:734–40.PubMedCrossRef Böhme J, Lägel A, Schmidt F, Tiemann AH, Josten C. Ligament healing results after type C pelvic ring fractures. results of triangular vertebropelvic support. Unfallchirurg. 2010;113:734–40.PubMedCrossRef
12.
Zurück zum Zitat Henes FO, Nüchtern JV, Groth M, Habermann CR, Regier M, Rueger JM, Adam G, Grossterlinden LG. Comparison of diagnostic accuracy of magnetic resonance Imaging and multidetector computed tomography in the detection of pelvic fractures. Eur J Radiol. 2012;81:2337–2342.PubMedCrossRef Henes FO, Nüchtern JV, Groth M, Habermann CR, Regier M, Rueger JM, Adam G, Grossterlinden LG. Comparison of diagnostic accuracy of magnetic resonance Imaging and multidetector computed tomography in the detection of pelvic fractures. Eur J Radiol. 2012;81:2337–2342.PubMedCrossRef
13.
Zurück zum Zitat Steiner CL, Trentz O, Labler L. Management of Morel-Lavallee lesion associated with pelvic and/or acetabular fractures. Eur J Trauma Emerg Surg. 2008;34:554–60.CrossRef Steiner CL, Trentz O, Labler L. Management of Morel-Lavallee lesion associated with pelvic and/or acetabular fractures. Eur J Trauma Emerg Surg. 2008;34:554–60.CrossRef
14.
Zurück zum Zitat Rhee WT, You SH, Jang YG, Lee SY. Lumbo-sacro-pelvic fixation using iliac screws for the complex lumbo-sacral fractures. J Korean Neurosurg Soc. 2007;42:495–8.PubMedCrossRef Rhee WT, You SH, Jang YG, Lee SY. Lumbo-sacro-pelvic fixation using iliac screws for the complex lumbo-sacral fractures. J Korean Neurosurg Soc. 2007;42:495–8.PubMedCrossRef
15.
Zurück zum Zitat Hussin P, Chan CY, Saw LB, Kwan MK. U-shaped sacral fracture: an easily missed fracture with high morbidity. A report of two cases. Emerg Med J. 2009;26:677–8.PubMedCrossRef Hussin P, Chan CY, Saw LB, Kwan MK. U-shaped sacral fracture: an easily missed fracture with high morbidity. A report of two cases. Emerg Med J. 2009;26:677–8.PubMedCrossRef
16.
Zurück zum Zitat Vilela MD, Gelfenbeyn M, Bellabarba C. U-shaped sacral fracture and lumbosacral dislocation as a result of a shotgun injury: case report. Neurosurgery. 2009;64:E193–4.PubMedCrossRef Vilela MD, Gelfenbeyn M, Bellabarba C. U-shaped sacral fracture and lumbosacral dislocation as a result of a shotgun injury: case report. Neurosurgery. 2009;64:E193–4.PubMedCrossRef
17.
Zurück zum Zitat Hunt N, Jennings A, Smith M. Current management of U-shaped sacral fractures or spino-pelvic dissociation. Injury. 2002;33:123–6.PubMedCrossRef Hunt N, Jennings A, Smith M. Current management of U-shaped sacral fractures or spino-pelvic dissociation. Injury. 2002;33:123–6.PubMedCrossRef
18.
Zurück zum Zitat Mouhsine E, Wettstein M, Schizas C, Borens O, Blanc CH, Leyvraz PF, Theumann N, Garofalo R. Modified triangular posterior osteosynthesis of unstable sacrum fracture. Eur Spine J. 2006;15:857–63.PubMedCrossRef Mouhsine E, Wettstein M, Schizas C, Borens O, Blanc CH, Leyvraz PF, Theumann N, Garofalo R. Modified triangular posterior osteosynthesis of unstable sacrum fracture. Eur Spine J. 2006;15:857–63.PubMedCrossRef
19.
Zurück zum Zitat Schildhauer TA, Bellabarba C, Nork SE, Barei DP, Routt ML Jr, Chapman JR. Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation. J Orthop Trauma. 2006;20:447–57.PubMedCrossRef Schildhauer TA, Bellabarba C, Nork SE, Barei DP, Routt ML Jr, Chapman JR. Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation. J Orthop Trauma. 2006;20:447–57.PubMedCrossRef
20.
Zurück zum Zitat Nork SE, Jones CB, Harding SP, Mirza SK, Routt ML Jr. Percutaneous stabilization of U-shaped sacral fractures using iliosacral screws: technique and early results. J Orthop Trauma. 2001;15:238–46.PubMedCrossRef Nork SE, Jones CB, Harding SP, Mirza SK, Routt ML Jr. Percutaneous stabilization of U-shaped sacral fractures using iliosacral screws: technique and early results. J Orthop Trauma. 2001;15:238–46.PubMedCrossRef
21.
Zurück zum Zitat Gribnau AJ, van Hensbroek PB, Haverlag R, Ponsen KJ, Been HD, Goslings JC. U-shaped sacral fractures: surgical treatment and quality of life. Injury. 2009;40:1040–8.PubMedCrossRef Gribnau AJ, van Hensbroek PB, Haverlag R, Ponsen KJ, Been HD, Goslings JC. U-shaped sacral fractures: surgical treatment and quality of life. Injury. 2009;40:1040–8.PubMedCrossRef
22.
Zurück zum Zitat Taguchi T, Kawai S, Kaneko K, Yugue D. Operative management of displaced fractures of the sacrum. J Orthop Sci. 1999;4:347–52.PubMedCrossRef Taguchi T, Kawai S, Kaneko K, Yugue D. Operative management of displaced fractures of the sacrum. J Orthop Sci. 1999;4:347–52.PubMedCrossRef
23.
Zurück zum Zitat Sabourin M, Lazennec JY, Catonne Y, Pascal-Moussellard H, Rousseau MA. Shortening osteotomy and sacro-sacral fixation for U-shaped sacral fractures. J Spinal Disord Tech. 2010;23:457–60.PubMedCrossRef Sabourin M, Lazennec JY, Catonne Y, Pascal-Moussellard H, Rousseau MA. Shortening osteotomy and sacro-sacral fixation for U-shaped sacral fractures. J Spinal Disord Tech. 2010;23:457–60.PubMedCrossRef
24.
Zurück zum Zitat Vallier HA, Cureton BA, Ekstein C, Oldenburg FP, Wilber JH. Early definitive stabilization of unstable pelvis and acetabulum fractures reduces morbidity. J Trauma. 2010;69:677–84.PubMedCrossRef Vallier HA, Cureton BA, Ekstein C, Oldenburg FP, Wilber JH. Early definitive stabilization of unstable pelvis and acetabulum fractures reduces morbidity. J Trauma. 2010;69:677–84.PubMedCrossRef
25.
Zurück zum Zitat Katsoulis E, Giannoudis PV. Impact of timing of pelvic fixation on functional outcome. Injury. 2006;37:1133–42.PubMedCrossRef Katsoulis E, Giannoudis PV. Impact of timing of pelvic fixation on functional outcome. Injury. 2006;37:1133–42.PubMedCrossRef
26.
Zurück zum Zitat Käch K, Trentz O. Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis. Unfallchirurg. 1994;97:28–38.PubMed Käch K, Trentz O. Distraction spondylodesis of the sacrum in “vertical shear lesions” of the pelvis. Unfallchirurg. 1994;97:28–38.PubMed
27.
Zurück zum Zitat Josten C, Schildhauer TA, Muhr G. Therapy of unstable sacrum fractures in pelvic ring. Results of osteosynthesis with early mobilization. Chirurg. 1994;65:970–5.PubMed Josten C, Schildhauer TA, Muhr G. Therapy of unstable sacrum fractures in pelvic ring. Results of osteosynthesis with early mobilization. Chirurg. 1994;65:970–5.PubMed
28.
Zurück zum Zitat Schildhauer TA, Ledoux WR, Chapman JR, Henley MB, Tencer AF, Routt ML Jr. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma. 2003;17:22–31.PubMedCrossRef Schildhauer TA, Ledoux WR, Chapman JR, Henley MB, Tencer AF, Routt ML Jr. Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: a cadaveric and biomechanical evaluation under cyclic loads. J Orthop Trauma. 2003;17:22–31.PubMedCrossRef
29.
Zurück zum Zitat Schildhauer TA, Josten C, Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma. 2006;20:S44–51.PubMed Schildhauer TA, Josten C, Muhr G. Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing. J Orthop Trauma. 2006;20:S44–51.PubMed
30.
Zurück zum Zitat Culemann U, Seelig M, Lange U, Gänsslen A, Tosounidis G, Pohlemann T. Biomechanical comparison of different stabilisation devices for transforaminal sacral fracture. Is an interlocking device advantageous? Unfallchirurg. 2007;110:528–36.PubMedCrossRef Culemann U, Seelig M, Lange U, Gänsslen A, Tosounidis G, Pohlemann T. Biomechanical comparison of different stabilisation devices for transforaminal sacral fracture. Is an interlocking device advantageous? Unfallchirurg. 2007;110:528–36.PubMedCrossRef
31.
Zurück zum Zitat Gänsslen A, Pape HC, Lehmann U, Lange U, Krettek C, Pohlemann T. Open reduction and internal fixation of unstable sacral fractures. Zentralbl Chir. 2003;128:40–5.PubMedCrossRef Gänsslen A, Pape HC, Lehmann U, Lange U, Krettek C, Pohlemann T. Open reduction and internal fixation of unstable sacral fractures. Zentralbl Chir. 2003;128:40–5.PubMedCrossRef
32.
Zurück zum Zitat Pohlemann T, Angst M, Schneider E, Ganz R, Tscherne H. Fixation of transforaminal sacrum fractures: a biomechanical study. J Orthop Trauma. 1993;7:107–17.PubMedCrossRef Pohlemann T, Angst M, Schneider E, Ganz R, Tscherne H. Fixation of transforaminal sacrum fractures: a biomechanical study. J Orthop Trauma. 1993;7:107–17.PubMedCrossRef
33.
Zurück zum Zitat Keel MJ, Benneker LM, Siebenrock KA, Bastian JD. Less invasive lumbopelvic stabilization of posterior pelvic ring instability: technique and preliminary results. J Trauma. 2011;71:E62–70.PubMedCrossRef Keel MJ, Benneker LM, Siebenrock KA, Bastian JD. Less invasive lumbopelvic stabilization of posterior pelvic ring instability: technique and preliminary results. J Trauma. 2011;71:E62–70.PubMedCrossRef
34.
Zurück zum Zitat König MA, Seidel U, Heini P, Orler R, Quraishi NA, Boszczyk AA, Boszczyk BM. Minimal-invasive percutaneous reduction and transsacral screw fixation for U-shaped fractures. J Spinal Disord Tech. 2011. König MA, Seidel U, Heini P, Orler R, Quraishi NA, Boszczyk AA, Boszczyk BM. Minimal-invasive percutaneous reduction and transsacral screw fixation for U-shaped fractures. J Spinal Disord Tech. 2011.
35.
Zurück zum Zitat Pohlemann T, Gänsslen A, Tscherne H. Fracture of the sacrum. Unfallchirurg. 2000;103:769–86.PubMedCrossRef Pohlemann T, Gänsslen A, Tscherne H. Fracture of the sacrum. Unfallchirurg. 2000;103:769–86.PubMedCrossRef
36.
Zurück zum Zitat Schildhauer TA, Josten C, Muhr G. Die trianguläre Osteosynthese instabiler Sakrumfrakturen. Operat Orthop Traumatol. 2001;13:27–42.CrossRef Schildhauer TA, Josten C, Muhr G. Die trianguläre Osteosynthese instabiler Sakrumfrakturen. Operat Orthop Traumatol. 2001;13:27–42.CrossRef
37.
Zurück zum Zitat Vilela MD, Jermani C, Braga BP. Lumbopelvic fixation and sacral decompression for a U-shaped sacral fracture: case report. Arq Neuropsiquiatr. 2007;65:865–8.PubMedCrossRef Vilela MD, Jermani C, Braga BP. Lumbopelvic fixation and sacral decompression for a U-shaped sacral fracture: case report. Arq Neuropsiquiatr. 2007;65:865–8.PubMedCrossRef
38.
Zurück zum Zitat Gibbons KJ, Soloniuk DS, Razack N. Neurological injury and patterns of sacral fractures. J Neurosurg. 1990;72:889–93.PubMedCrossRef Gibbons KJ, Soloniuk DS, Razack N. Neurological injury and patterns of sacral fractures. J Neurosurg. 1990;72:889–93.PubMedCrossRef
39.
Zurück zum Zitat Borg T, Holstad M, Larsson S. Quality of life in patients operated for pelvic fractures caused by suicide attempt by jumping. Scand J Surg. 2010;99:180–6.PubMed Borg T, Holstad M, Larsson S. Quality of life in patients operated for pelvic fractures caused by suicide attempt by jumping. Scand J Surg. 2010;99:180–6.PubMed
Metadaten
Titel
Management of traumatic spinopelvic dissociations: review of the literature
verfasst von
W. Lehmann
M. Hoffmann
D. Briem
L. Grossterlinden
J. P. Petersen
M. Priemel
P. Pogoda
A. Ruecker
J. M. Rueger
Publikationsdatum
01.10.2012
Verlag
Springer-Verlag
Erschienen in
European Journal of Trauma and Emergency Surgery / Ausgabe 5/2012
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-012-0225-7

Weitere Artikel der Ausgabe 5/2012

European Journal of Trauma and Emergency Surgery 5/2012 Zur Ausgabe

Editorial Comment

Editorial Comment 

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.