Unique combination of lumbosacral junction injury with open pelvic ring disruption and acetabulum fracture: case report

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2005-08, Vol.30 (16), p.E477-E480
• Main Authors: Papakostidis, Costas, Harwood, Paul, Dimitriou, Rozalia, Dunsmuir, Robert, Millner, Peter, Giannoudis, Peter V
• Format: Article
• Language: English
• Subjects: Acetabulum - injuries; Adolescent; Fractures, Bone - diagnosis; Fractures, Bone - surgery; Humans; Internal Fixators; Lumbar Vertebrae - injuries; Magnetic Resonance Imaging; Male; Pelvic Bones - diagnostic imaging; Pelvic Bones - injuries; Sacrum - injuries; Spinal Fractures - diagnosis; Spinal Fractures - surgery; Spinal Fusion; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/01.brs.0000174280.85073.ca

A case report of a complex spondylo-pelvic injury combining a traumatic spondylolysis and burst fracture of the fifth lumbar vertebra, with an open pelvic ring disruption and a fracture of the acetabulum. To describe the mechanism, diagnostic approach, and rationale for treatment of this very rare and complex injury pattern, and finally to present the results of the treatment. Traumatic spondylolysis of the fifth lumbar vertebra is a very uncommon type of injury, with few cases being reported in the literature. Combination of such an injury with pelvic ring and acetabular fractures has never been reported in the past. The patient was referred to our institution for definitive treatment after initial treatment at a local hospital involving laparotomy, defunctioning colostomy, and symphyseal plating. Accurate delineation of the complex injury pattern was established on computerized tomography with 3-dimensional multiplanar reconstruction, and magnetic resonance imaging of both the spine and pelvis. Definitive stabilization of the injury was made by posterior lumbopelvic segmental fixation with posterolateral fusion and open reduction and internal fixation of the acetabular fracture. At 2 years after surgery, the patient was ambulatory, with an ankle-foot orthosis, and almost completely pain free. He was able to perform manual work. Complex associated injuries of the spondylo-pelvic junction and pelvis are always a challenge to treat because they demand careful assessment, stabilization of the patient, meticulous imaging, and a multidisciplinary approach.