Combat-related lumbopelvic dissociation treated with percutaneous sacroiliac screw placement

Abstract

A 25-year-old male active duty soldier injured in an improvised explosive device blast sustained a stable U-type sacral fracture (S1/S2, bilateral Zone II) with 20° sacral kyphosis (Fig. 1, Fig. 2). The patient also sustained left L5 transverse process and facet fracture with L5/S1 retrolisthesis. He had no neurologic deficits on arrival to our institution and was placed in a thoracolumbar support orthosis for his lumbar spine injury. On postinjury Day 12, the patient underwent bilateral SI screw placement. Six-months postoperative, the patient had resumed jogging activities without difficulty and did not exhibit lower extremity weakness, bowel/bladder dysfunction, or perineal numbness. Postoperative radiographs demonstrate adequate screw placement without evidence of progressive kyphosis, implant failure, or loosening (Fig. 3). The patient was released for activity as tolerated. At our institution, we have seen an increased incidence of lumbopelvic dissociation injury because of the high-energy blast mechanisms associated with combat in current conflicts. The patient in the above case did not require posterior decompression because of lack of neurologic compromise and was managed with bilateral sacroiliac screw placement, which has shown comparable results with regard to fracture healing and neurologic recovery [ 1 Nork S.E. Jones C.B. Harding S.P. et al. Percutaneous stabilization of U-shaped sacral fractures using iliosacral screws: technique and early results. J Orthop Trauma. 2001; 15: 238-246 Crossref PubMed Scopus (188) Google Scholar , 2 Schildhauer T.A. Bellabarba C. Nork S.E. et al. Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation. J Orthop Trauma. 2006; 20: 447-457 Crossref PubMed Scopus (168) Google Scholar ].