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At least 19 recordsLinked to original sources

PubMed1992

[The problem of the sacrum fracture. Clinical analysis of 377 cases].

Sacral fractures are rare injuries that are often neglected because of the general severity of the patient's injuries. They are typical injuries in patients with polytraumata. A "hidden" injury, they are often diagnosed late or are even missed. In a well-documented consecutive series of 1,350 patients with pelvic fractures treated in the trauma department of the Hannover Medical School between 1972 and 1991, a total of 377 sacrum fractures were evaluated in a retrospective study. The cause of the accident, mechanism of injury, concomitant injuries, diagnostic procedures, classification of the pelvic injury (TILE), as well as the classification of the sacrum injury (DENIS), treatment and outcome were analyzed in all cases. Observed complications with special attention to injuries to the lumbosacral plexus were correlated with the classification of the sacrum and pelvis, as well as with a detailed analysis of the fracture pattern and fracture characteristics. In 89.4% at least one additional body region was injured in these patients. PTS (Hannover Polytrauma Score) groups III and IV included 42.5% of the patients. With an improved diagnostic protocol (radiological a.p. views, oblique views and CT scan), the observed rate of sacrum fractures was 33%. Neurological deficits occurred in 15.1% of the patients. In contrast to the literature, the rate of neurological deficits was related more to the degree of pelvic instability (TILE) than to the specific fracture pattern in the sacrum. In stable injuries (TILE A) neurological deficits were only seen in exceptions. In type B injuries the maximum rate was 10%, whereas in unstable fractures (TILE C) the rate of neurological deficits was 32.6% in transalar fractures (DENIS zone I), 42.9% in transforaminal fractures (DENIS zone II), and 63.6% in central fracture types (DENIS zone III). Additional risk indicators for neurological impairment are avulsion fractures of the sacrum, comminuted and bilateral fracture lines. The fracture classification should thus be modified. Our own experience with operative therapy for sacral fractures (open revision of the sacral plexus together with internal stabilization of the fracture) is still limited, but based on the experience presented, further development of the treatment protocol for sacrum fractures should be considered.

Adolescent↗

PubMedDate not supplied

[CT in the surgical planning in tumorous processes of the sacrum].

The value of CT in the preoperative management of tumors of the sacrum is demonstrated. Essential informations for treatment planning are: involved sacral segment, infiltration of sacral foramina and nerve roots, involvement of the sacroiliac joints, ingression of the lumbar spine, infiltration of the pelvic organs and vessels, sciatic nerve and the dorsal soft tissues. In order to prove the competence of the CT in answering these questions we evaluated the CT-examinations of 30 pat. with 14 primary tumors, 9 metastatic tumors and 7 tumors involving secondary the sacrum. The CT findings were correlated with clinical symptoms and surgical reports in 11 pat., with clinical symptoms alone in 19 pat. There was good correlation in the criterias: location and number of involved segments (8/11, 17/19), infiltr. of SI-joints (11/11), infiltr. of lumbar spine (9/11, 18/19), and infiltr. of pelvic organs (10/11), worse correlation in the criterias: nerve root-involvement (2/11, 3/19), and sciatic nerve-infiltr. (7/11, 15/19). Our conclusions are that CT gives helpful preoperative informations deciding about extent of surgical procedure, and surgical approach. The major problem, however, consist in diagnosis of nerve root and sciatic nerve involvement, therefore in poor prediction of postoperative conservation of neural functions. The knowledge of CT-anatomy of sacrum- and important condition for correct segment-location of the tumor is refreshed by outlines of characteristic segmental CT-sections of the sacrum.

Adult↗

PubMed1990

[Giant-cell tumor of the sacrum: an analysis of 10 cases].

Giant-cell tumor of the sacrum is rare. There were only a few reports of large series in the literature. From 1960-1988 a total of ten cases giant-cell tumor of the sacrum were treated in our Department. The average age of the patients was 34 years (with range of 19-49 years). The lesions located in the proximal parts of the sacrums in 8 cases, and in S3-5 in another 2 cases. of 10, 7 were treated with en bloc resection or subtotal resection. of the sacrum, and followed by irradiation in 5 of 7 cases (with range of 2000r-4500r). All the 7 cases were followed up without any evidence of local recurrence or distant metastases. The average follow-up period was 10.3 years (with range of 1.5-27.5 years). The rectal, bladder and sexual function were normal or restored. The other 3 cases, biopsied in 2, partially resected in 1, died less than one year after diagnosis. Comparing the died group with the survival group, we concluded that early diagnosis and thorough excision of the tumor are the two decisive factors for a favorable prognosis.

Adult↗

PubMed1989

[The biostatics of the human sacrum: is there a relationship between the sacral inclination and the spatial orientation of the upper articular process of the sacral plate?].

The orientation of the superior articular processes with regard to the upper end-plate of the sacrum does not depend on the inclination of the sacrum. This assertion can be made by interpreting certain angles already described in literature and may be confirmed by a research following strict biomechanic principles: The orientation of the articular processes is put in relation to the direction of the forward shear brought upon by the Vth lumbar vertebra and caused by the inclination of the sacrum. This is achieved by measuring the angle between the articular facet and a plane normal to the mentioned forward shear. The result is that the size of this angle does not at all depend on the degree of the inclination of the sacrum.

Adult↗

PubMed1989

Measurement of soft tissue thickness over the sacrum of elderly hospital patients using B-mode ultrasound.

The thickness of soft tissues over the sacrum of elderly hospital in-patients has been measured using B-mode ultrasound. Forty patients were scanned, of which nine had recognizable superficial pressure sores at the sacrum. No correlation was found between the depth of soft tissue and either age or Norton score. Patients with sores had less soft tissue over the sacrum (p less than 0.025). Excluding one patient whose sacral sore appeared to be the final stage of the healing process, the remaining eight all had less than 8.5 mm of sacral soft tissue cover. Five patients without sacral sores also had less than 8.5 mm of sacral soft tissue cover. However, a combination of the presence of incontinence and the depth of sacral soft tissue cover identified seven of the eight patients with sacral sores with no inclusion of patients without sores.

Aged↗

PubMed1992

Fractures of the sacrum and disk herniation: rare lesions in the pediatric surgical patient?

Fractures of the sacrum and lesions of the intervertebral disks are seldom reported in childhood and adolescence. In our report, illustrated by three representative cases that we treated during the past six months, we show that sacrum fractures, not an easy diagnosis, may be more frequent than currently assumed, and that in quite a number of children and adolescents an anterior pelvic fracture may in fact be an unrecognized Malgaigne type pelvic fracture with a posterior fracture plane cutting through the sacrum. They may be accompanied by herniations and/or lacerations of intervertebral disks.

Adolescent↗

PubMed1976

Fracture-dislocations of the sacrum. Report of three cases.

The pattern of fracture-dislocation of the upper part of the sacrum is demonstrated in three patients. The fracture line followed the segmental form of the sacrum and was usually caused by a posterior force against the pelvis which had been locked by hip flexion and knee extension. Fractures of the lumbar transverse processes also occurred, presumably from avulsion by the quadratus lumborum muscle. The damage to the sacral plexus found in all three cases recovered after several months. Radiographs of the injury are difficult to obtain in severely injured patients but oblique views of the sacrum help to determine the extent of the forward dislocation.

Adult↗

PubMed1990

Pelvic stabilisation of a large chordoma of the sacrum. Description of a case.

Chordoma is a primary malignant bone tumour which derives form residue of the notochord. It constitutes 1.4% of all primary bone tumours, and in approximately half the cases it is localised in the sacrum. It is characterised by slow growth, but also by high local invasiveness, local recurrence and pulmonary metastasis. The literature reports many cases of chordoma of the sacrum, most of which do not extend beyond the second sacral metamere. The case presented here is a large chordoma which extended proximally as far as the 1st sacral metamere bilaterally, so that subtotal resection of the sacrum was required. There is very little data in the literature on the stability of the pelvis after such ample removal. Considering the young age of the patient we decided to stabilise the pelvis with Luque segmental instrumentation.

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↗

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↗

PubMed1990

Long scoliosis fusion to the sacrum in adults with nonparalytic scoliosis. An improved method.

The first 17 adults with nonparalytic scoliosis having long fusion to the sacrum treated with the Luque-Galveston technique were reviewed. There were 3 men and 14 women. Their average age at the time of surgery was 47 years and the mean follow-up period was 42 months. There were no neurologic complications and no patient developed significant loss of lumbar lordosis. Fusion occurred in 88% of patients. Two patients developed pseudarthrosis, neither of whom had anterior fusion at the level of pseudarthrosis. The best results occurred in patients who had two-stage procedures, with initial anterior lumbar fusion to the sacrum without instrumentation followed by posterior segmental instrumentation with the Galveston technique of fixation to the pelvis.

Female↗

PubMed1992

Technique and results of fixation to the sacrum with iliosacral screws.

This article describes the technique of iliosacral screw fixation, as well as a retrospective review of 28 consecutive patients who had spine fusion to the sacrum with iliosacral screws, with a minimum follow-up of 2 years. The study included 6 male and 22 female patients. Average age at the time of surgery was 43 years, and mean follow-up time was 3.5 years. There were no neurologic complications at final follow-up evaluation. Ninety-five percent of the patients had radiographic evidence of fusion. Three patients required iliosacral screw removal because of suboptimal intraoperative Kirschner-wire placement. Optimal intraoperative radiographic evaluation for accurate iliosacral screw placement is recommended. The use of iliosacral screws is also a useful addition to the armamentarium of the spine surgeon when fixation to the sacrum is required.

Adult↗

PubMed1977

The lateral view in radionuclide imaging of the sacrum.

Radionuclide bone images in the anterior and posterior views failed to demonstrate a large metastatic tumor involving the sacrum which was obvious on the lateral view. Evaluation of the sacrum by radionuclide imaging may be incomplete without the lateral projection, particularly when there is a question of false-negative anterior and posterior views or difficulty in interpreting the radionuclide images.

Adult↗

PubMed1990

Insufficiency fractures of the sacrum after radiotherapy for gynaecological malignancy.

An entity is described which is characterized by low back pain and increased radionuclide uptake in the sacrum at bone scintigraphy in postmenopausal women having received radiotherapy towards the pelvis because of gynaecological malignancy. The findings stimulate bone metastases, but are in all likelihood caused by insufficiency fractures of the sacrum promoted by bone weakness induced by postmenopausal osteoporosis and radiotherapy combined. The increased radionuclide activity has a characteristic appearance which in the fully developed fracture acquires the shape of an 'H'. In plain radiography, changes are absent or subtle. The proper complementary examination is CT, in which the fractures can be visualized and malignant changes excluded. Awareness of this benign entity is important to avoid overdiagnosis of bone metastases.

Aged↗

PubMed1976

Pelvic strength after major amputation of the sacrum. An exerimental study.

Major sacral resections up to the level of S 1 and even higher have been performed. This has raised the question of the degree to which such operations weaken the pelvic ring. Fifteen cadaver pelves, including the fifth lumbar vertebra, were loaded to failure, five unresected, five after resection of the sacrum between S 1 and S 2, and five after resection about 1 cm below the promontory. The weakening of the pelvic ring amounted to approximately 30 per cent with the former type of resection and 50 per cent with the latter. Taking into consideration the calculated normal load on L 5 in upright standing it seems safe from this study to allow patients to stand with full weight-bearing at an early stage postoperatively after submaximal resection of the sacrum.

Adult↗

PubMed1992

[Sacrum abnormalities and neural tube closure defect: different manifestations of a same genetic disease?].

The authors report the case of a full-term female infant exhibiting an anterior meningocele, combined with a hemi-sacrum and an anal dysfunction. Both her father and brother had the same although less pronounced abnormalities. The father's sister was anencephalic. This case, together with previously published data, suggests that sacrum malformations and neural tube defects may derive from a unique dominant autosomal gene with variable expressivity.

Female↗

PubMed1991

Treatment of adult spinal deformity with fusion to the sacrum using CD instrumentation.

The effectiveness of Cotrel-Dubousset (CD) instrumentation in long fusions to the sacrum for adult spinal deformity was evaluated in 27 consecutive patients. The CD system provided acceptable correction of kyphosis and scoliosis while restoring or maintaining lumbar lordosis. However, the standard CD pelvic fixation using sacral pedicle and alar screws was problematic. Instrumentation-related complications were frequent (70%). Sagittal and frontal plane balance was difficult to achieve and not consistently maintained. The CD system using sacral pedicle and alar screws in the adult patient does not appear to offer advantages over alternative techniques for achieving arthrodesis to the sacrum for adult deformity.

Adult↗

PubMed1990

[Insufficiency fracture of the sacrum].

Three cases of insufficiency fracture of the sacrum are reported. Cortical disruption and linear sclerosis with or without linear fracture line at the upper sacral segment parallel to the sacroiliac joint are characteristic. Bone scintigram is suitable for screening, but plain radiographic and CT findings are diagnostic. Insufficiency fracture of the sacrum should not be confused with other conditions, such as metastatic disease.

Aged↗