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At least 91 records · Page 5Linked to original sources

PubMed1999

Abdominosacral resection of recurrent rectal cancer in the sacrum.

PURPOSE: Resection of the sacrum is the only curative therapy of isolated sacral recurrence after primarily resected rectal cancer. The aim of the study was to assess whether there is a benefit in terms of overall survival, morbidity, and mortality when sacrum resection is performed more radically and in cooperation between colorectal and orthopedic surgeons. Possible prognostic factors were also assessed. METHODS: Twelve consecutive patients who underwent interdisciplinary partial sacral resection were included in a retrospective cohort study. Furthermore, overall survival rate and survival time were calculated. RESULTS: Histologic examination showed tumor-free resection margins in all cases. Extended resection was necessary in seven patients, including total pelvic exenteration in two. No perioperative death occurred and no patient required early reoperation. Complications were observed in 42 percent of patients, mainly caused by poor wound healing. All patients experienced relief from pain. One-year and three-year overall survival rates were 50 and 17 percent, respectively. The overall mean survival time was 21.7 months. Patients who died of recurrent disease within one year either underwent former resection for locoregional recurrence, had extensive local recurrent tumors affecting pelvic visceral structures, or retrospectively suffered from metastatic sacral tumor manifestation. CONCLUSION: The mortality and morbidity rates observed in the present study seem to justify partial sacral resection as a means to achieve palliation of perineosacral pain in spite of rare overall long-term survival.

Adenocarcinoma↗

PubMed1983

Radiation induced osteosarcoma of the sacrum following radiation of an undiagnosed bone lesion.

Years ago a 20-year-old patient presented with low back pain. Radiologically a cystic lesion of the sacrum was found and interpreted as malignant tumor. Without biopsy and histological diagnosis the patient was given radiation therapy with 21 000 rad. One year later a similar lesion was radiated in the left femoral neck. A pathological fracture ensued recessitating several operations. Twenty years after initial radiation therapy the patient developed a rapidly growing tumor of the sacrum, metastasizing to the lungs. One year later he died.

Adult↗

PubMed1996

[Impalement injury of the colon, iliac vein and sacrum--a rare combination in penetrating abdominal trauma. A case report].

We report on the treatment of a patient who sustained a penetrating abdominal wound with injury of the left common iliac vein, the sigmoid colon and the sacrum in a motorbike accident. The left iliac vein injury was treated using a Gore-Tex vein patch and an A-V fistula. The colon was restored after an intraoperative washout. The punched fragment of the sacrum was removed. An additional fracture of the proximal left humerus was managed with an osteosynthesis in a second operation. The principles of management of combined colon and vascular injuries are discussed and a short review of the literature is given.

Abdominal Injuries↗

PubMed1999

[Pseudarthrosis of an occult fracture in zone III of the sacrum].

Fractures in the midline of the sacrum are rare, a pseudarthrosis has not been described previously. We report about a 53-year-old woman with a midline fracture of the sacrum which has not been recognized, although there were indirect fracture signs on the native x-rays and a CT was performed. The surgical treatment with sacral compression bars was successful and pseudarthrosis healing resulted but the patient continued to have mild low back pain. The case reported here confirms that low back pain may caused by pathologic changes of the posterior part of the pelvis. The unusual fracture location could be caused by a bifid spinous process.

Female↗

PubMed1999

Bilateral fracture of the sacrum associated with pregnancy: a case report.

We describe a 33-year-old woman with a bilateral fracture of the sacrum associated with pregnancy. Dual-energy X-ray absorptiometry of the lumbar spine and femoral neck showed normal bone mineral density, whereas bilateral osteopenic areas in the massae laterales were demonstrated by the initial CT-scan. The question remains whether the correct diagnosis is so-called insufficiency fracture due to transient osteoporosis of the sacrum associated with pregnancy or so-called fatigue fracture due to unaccustomed stress related to rapid and excessive weight gain in the last trimester of pregnancy.

Absorptiometry, Photon↗

PubMed2003

Aneurysmal bone cysts of the sacrum. Clinical report and review of the literature.

BACKGROUND: Aneurysmal bone cysts, first described by Jaffe and Lichtenstein in 1942, are benign lesions that may easily be mistaken for a malignant tumor both radiographically and pathologically. These diagnostic problems are due to their rapid growth, extensive destruction of bone, wide extraosseous tumor masses, and marked cellular exuberance. The differential diagnosis of aneurysmal bone cysts including giant cell tumor, calcified solitary bone cysts, low-grade osteosarcoma, and teleangiectatic osteosarcoma becomes even more complicated when the lesion arises at sites other than the long bones and presents with extensive extraosseous, soft-tissue tumor masses. The latter cases--especially when they occur as sacral or presacral tumors--present challenges with respect to successful treatment, which should combine surgical removal of the entire lesion following oncological criteria to prevent recurrences and osteosynthesis to guarantee the biomechanical stability of the spinal-pelvic junction. Here we report on the clinical case of a female patient with an aneurysmal bone cyst of the sacrum and extensive extraosseous tumor masses. The report includes the diagnostic challenges, the surgical options of sacral and/or presacral tumors, the histopathological findings, and long-term clinical and radiographic surveillance. METHODS: The patient was treated by a combination of preoperative adjuvant selective arterial embolization, radical surgical excision through an anterior approach followed by subsequent osteosynthesis and stabilization through a posterior approach. RESULTS: Clinical and radiographic follow-up for 2 years was uneventful, and the patient is still free of recurrence or any complaints. CONCLUSION: The current report documents the diagnostic and surgical challenge of a gigantic aneurysmal bone cyst of the sacrum and its successful management.

Adolescent↗

PubMed2006

The femoro-sacral posterior angle: an anatomical sagittal pelvic parameter usable with dome-shaped sacrum.

The sagittal pelvic morphology modulates the individual alignment of the spine. Anatomical angular parameters were described as follows: the "Pelvic Incidence" (PI) and the Jackson's angle "Pelvic Lordosis" (PR-S1). Significant chains of relationships were expressed connecting these angles with pelvic and spinal positional parameters. This allows an individual assessment of the harmony of the sagittal spinal balance. But in case of spondylolysis with high-grade listhesis, the upper plate of the sacrum shows a dome-shaped deformity. The previous anatomical parameters are therefore imprecise. Indeed, the anterior part of the sacrum being inaccurate, an exact assessment of these angles becomes impossible. Therefore, we propose a new angular parameter named "Femoro-Sacral Posterior Angle" (FSPA): the angle between the posterior wall of the first sacral vertebra, always well definite, and the line connecting the posterior part of the sacral plate to the femoral axis. The validation of this parameter was performed and compared with the classical published parameters. It showed good inter-observer reliability, even with dome-shaped sacral plate. In spite of lower correlation with the positional parameters than those observed with PI or PR-S1, the FSPA appeared to be reliable and precise for an exact evaluation of the sagittal spino-pelvic balance is case of spondylo-listhesis with dome-shaped sacral endplate.

Adolescent↗

PubMed2000

A simplified Galveston technique for the stabilisation of pathological fractures of the sacrum.

Mechanical stabilisation of pathological fractures of the sacrum is technically challenging. There is often inadequate purchase in the sacrum, and stabilisation has to be achieved between the lumbar vertebrae and ilium. We present a simplification of the Galveston technique. We treated a total of six patients with this technique, four for metastatic disease and two for primary tumours. Our technique consists of the formation of a proximal stable construct using ISOLA pedicle screws linked distally using a modular system of connectors to threaded iliac bolts with cross linkages. Neurological decompression and fusion was performed as appropriate. The benefits of this method are: ease of access to the ilium, a solid purchase to the ilium, less rod contouring and shorter operating time. We have had no operative complications from this procedure. All patients were discharged home mobile, with a reduced opiate requirement.

Adolescent↗

PubMed1999

Operative management of displaced fractures of the sacrum.

Displaced fractures of the sacrum are often associated with mechanical instability and neurologic deficits that cause late musculoskeletal problems and pain. We describe the radiologic and neurologic characteristics of 12 displaced fractures of the sacrum, (in 5 men and 7 women; age at injury, 17-61 years) as well as the management and results. Seven patients had unilateral longitudinal fractures (ULF), and 5 had bilateral longitudinal fractures (BLF) with a transverse fracture. All patients had mechanical instability (rotational and/or vertical). Seven (58%) had neurologic deficits. ULFs were stabilized with iliosacral screws. BLFs were stabilized with transiliac screws (for the longitudinal fractures), and with plates (for the transverse fractures). If neurologic deficits were present, a laminectomy was performed to explore and decompress nerve roots. The duration of follow-up ranged from 23 to 82 months (mean, 47 months). Eleven patients had no pain. Ten of the 12 patients were able to walk without any aids, while 2 patients needed foot apparatuses to walk. All patients showed union of the sacral fracture and a stable pelvis. Two patients did not recover neurologically; 1 patient with ULF had undergone late decompression for chronic radiculopathy and the other, with BLF, had had complete paralysis pre-operatively. Five patients with incomplete paralysis recovered both sensory and motor function. If a patient with a sacral fracture has instability, operative treatment with anatomical reduction is preferred.

Adolescent↗

PubMed1988

Morbidity following isolated fractures of the sacrum.

There is little information in the orthopaedic literature on the long-term results following isolated fractures of the sacrum. The present study traced patients with these fractures, and attempted to identify the incidence of long-term symptoms. The study revealed that isolated fractures of the sacrum are not always benign, and may result in chronic discomfort (sacrodynia) or persistent neurological symptoms.

Adult↗

PubMed1989

Comparison of contact pressures measured at the sacrum of young and elderly subjects.

Contact (interface) pressure measurements were made between the sacrum of groups of young and elderly subjects lying upon two special mattresses used to prevent pressure sores. One mattress was an alternating air pressure mattress, the other a foam mattress. Contact pressures were measured using a hydraulic sensor taped directly to the skin over the sacrum. All mean pressures and 'pressure impulses' (total applied pressure per standard time period) appeared higher when measured among the elderly subjects. Compared with the pressures measured from young subjects, the maximum contact pressures were significantly higher (p less than 0.05) on both mattresses, with the pressure impulse higher while lying upon the foam mattress (p less than 0.05).

Adult↗

PubMedDate not supplied

Hemangioendothelial sarcoma of the sacrum: CT findings.

A hemangioendothelial sarcoma (angiosarcoma) of the sacrum was discovered by computed tomography (CT) in a patient with a fever of undetermined origin. A CT-directed fine needle biopsy of the lesion helped establish the diagnosis. Plain radiographs revealed only very subtle changes in the sacrum and a bone scan was negative. A literature search revealed no previous descriptions of the CT appearance of this rate primary bone neoplasm.

Aged↗

PubMedDate not supplied

[Transverse fracture of the sacrum: value of imaging. A case report].

Transverse fractures of the sacrum with major displacement are rare and often misdiagnosed. A case of transverse fracture of the sacrum with cauda equina injury is reported. The diagnosis was not recognized initially. Conventional radiographs of the pelvis failed to demonstrate the fracture. True lateral sacral views and CT scan with reconstructions allowed analysis of the different sagittal fracture lines to facilitate surgical planning. These examinations should be considered in all patients with history of high energy trauma and clinical signs indicating lumbosacral injury.

Adolescent↗

PubMed2003

[Open reduction and internal fixation of a displaced transverse fracture of the sacrum with a locking compression plate].

Isolated fractures of the distal sacrum are usually caused by direct trauma. Undisplaced fractures are easily missed on conventional X-ray films. CT scans can disclose the full extent of the fracture. Undisplaced, or minimally displaced fractures can be treated conservatively with analgesics and a restriction to seat for six weeks. In cases of major displacement or neurological symptoms, a digital transanal reduction of the fracture under local or regional anaesthesia can be attempted. If this manoeuvre fails, open reduction and internal fixation are required. Stabilisation is challenging because of the thin bone and the complex shape of the sacrum. In a 15 year old girl with major horizontal displacement and comminution of S4, following a snowboard accident, we achieved sufficient and stable fixation with the new LCP (Locking Compression Plate) system. For six weeks after the operation, the patient was not allowed to sit down. Thereafter, she was free of pain and unrestricted in daily activities and sport. The LCP system has a number of advantages in the fixation of fractures in osteoporotic or thin bone, but clinical experience/skill and careful planning of the operation are crucial.

Adolescent↗

PubMed1999

Surgical treatment of malignant tumours of the sacrum.

AIMS: We assessed the results of surgical treatment of malignant sacral tumours and aimed to supply information on incidence and distribution of these lesions. METHODS: Forty-six malignant cases out of 65 tumours of the sacrum were assessed retrospectively. Three of the patients did not accept treatment. Surgical treatment was applied to 23 (65.2%) of the remaining 43 patients. Surgical techniques used were resection and PMMA (polymethylmethacrylate) application through a posterior approach, sacral reconstruction, and resection through a combined posterior and anterior approach. RESULTS: Twelve of the lesions were primary while 34 were secondary. Among the primary sacrum tumours, the most common was chordoma (six cases, forming 9.2% of all the sacral lesions). Of a secondary sacral lesions, nine cases of breast carcinoma were found, forming the most common group. The recurrence rate was 23.3%. CONCLUSIONS: Chordoma was the most common primary sacral tumour, but found no incidence of giant cell tumour which has been previously reported as the second most common primary sacral tumour. We believe the posterior approach for resection of the tumour is sufficient in most instances and lumbopelvic instability must be prevented by reconstructive procedures.

Bone Neoplasms↗

PubMed1981

[The anatomy, radiology and clinical features of fractures of the sacrum (author's transl)].

In the presence of multiple injuries, 30% of fractures of the sacrum are missed on the first examination. The clinical features are non-specific and are often obscured by other injuries. Interruption or displacement of contrast lines on the A. P. view, if bilateral, are definite evidence of a fracture. In evaluating films of the sacrum it is therefore recommended that these lines be examined carefully. Such changes were found in two thirds of longitudinal and one third of horizontal fractures. Special attention should also be paid to the lateral and cranial articular processes, since these are areas of weakness in the pelvis and are predisposed to fracture.

Accidents, Traffic↗

PubMed1991

An unusual type of fracture in the upper sacrum.

An unusual type of indirect isolated fracture of the upper sacrum is presented. The upper sacrum was markedly comminuted and nondisplaced relative to the lower fragment. There was a neurologic deficit present. On the basis of a review of the literature, a previous classification system and the actual fracture mechanism, this fracture is classified as a special type; type 4, or the neutral position fracture.

Female↗

PubMed1993

Fixation of transforaminal sacrum fractures: a biomechanical study.

A transforaminal fracture of the sacrum usually represents the posterior part of an unstable pelvic ring fracture and is associated with a high rate of neurological complications. Nerve root decompression combined with open reduction and internal fixation (ORIF) can be beneficial. Present fixation methods have the disadvantage of extensive bilateral posterior approaches and fixation across the sacroiliac joint. Three methods of internal fixation of the sacrum were compared in a biomechanical study using six fresh pelvic specimens. A fracture model consisting of a transforaminal osteotomy combined with a symphysis disruption in a single-leg stance was used. Standard Harrington sacral bars, an internal fixator, and a newly developed stabilization technique using adapted standard AO/ASIF small-fragment implants ("local osteosynthesis") were compared. Three-dimensional measurement of the fragment movement (goniometer system) showed a maximum displacement of 4.0-4.5 mm after maximal loading (990-1,181 N) and no differences among the implants. The failure load related to body weight was 85% for sacral bars, 74% for the local osteosynthesis, and 58% for the internal fixator. Major displacement under loading was observed in the direction of the foramen axis. The new osteosynthesis technique showed strength comparable to the clinically successfully applied method of stabilization with sacral bars. It adds the theoretical advantage of a minimized approach, without fixation and thus without involvement of the SI joints.

Biomechanical Phenomena↗