Isolated transverse sacral fractures.

BACKGROUND CONTEXT: The limited literature available about transverse sacral fractures describes two populations of patients: one with severe associated injuries and neurologic impairment and another with insufficiency fractures after low-energy trauma. Nevertheless, we have observed that isolated sacral fractures can occur in a third group of patients without the previously described features. PURPOSE: To describe the clinical features of a population of patients with isolated transverse sacral fractures and evaluate the results of their conservative treatment according to our experience. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: Forty-two patients with isolated transverse sacral fractures with a mean follow-up of 22 months (range, 18-24 months). OUTCOMES MEASURES: Neurologic recovery, pain relief, time out of work, and disability. METHODS: We included all the patients admitted at our institution for an isolated transverse sacral fracture between 1996 and 2005. The information obtained from their medical records was analyzed using an electronic spreadsheet (Microsoft Excel for Mac v.2011; Microsoft, Redmond, WA, USA). RESULTS: Thirty-four patients (80%) sustained a low-energy trauma, whereas only two (4.8%) presented transient neurologic impairment. Every fracture was confirmed with a sacrococcygeal computed tomography (CT) scan. All the patients referred no local pain 6 months after the accident and were able to return to their preinjury activity level. None of the patients required compensation for disability. CONCLUSION: Transverse sacral fractures should be suspected in patients referring local pain after sustaining low-energy trauma, even in the absence of risk factors for an insufficiency fracture. These injuries are difficult to detect in plain X-rays, so a sacrococcygeal CT scan is recommended. Conservative treatment is associated with excellent results in this population of patients.

Thoracic spine fractures: injury profile and outcomes of a surgically treated cohort.

There are only few reports in literature about the treatment of traumatic lesions of the thoracic spine. They have been grouped together with thoracolumbar fractures, ignoring the particular biomechanics of the thoracic segment. The objective of this retrospective cohort is to describe the clinical presentation and outcomes of surgically treated patients with these injuries. Data were obtained from the institutional database of medical registries, identifying all the patients who had been treated for thoracic spine fractures, from January 1, 1995 through December 31, 2005 in our institution. The study group included the 51 surgically treated patients. General and surgery-related complications were considered as clinical outcomes and injury-related disability was also assessed. Statistical analysis evaluating possible associations with timing and type of surgery, neurological impairment and associated injuries was carried out. Motor vehicle accident was the most frequent mechanism of injury. Six patients had an incomplete neurological deficit, whereas 22 had a complete lesion. Thirty-two patients presented at least one complication. Five of the neurologically intact patients, while 20 of those with neurological impairment presented general complications (p = 0.0001). None of the patients' neurological status deteriorated after surgery. All patients with complete spinal cord injury and those with incomplete cord injury with partial functional recovery received disability compensation. Short pedicle instrumentations should be used whenever possible, but also long instrumentations and mixed constructs may be necessary for the management of such unique fractures.

Speed hump spine fractures: injury mechanism and case series.

STUDY DESIGN: Retrospective case series. OBJECTIVES: To describe an injury mechanism and a series of patients with spine fractures after passing over speed humps in a motor vehicle. SUMMARY OF BACKGROUND DATA: The use of speed humps as an effective measure to reduce the rate of traffic accidents is still a matter of discussion. Furthermore, their use in mass transport routes may cause spine injuries among passengers in motor vehicles. METHODS: Review of the database in our medical records, identifying all the patients with spine fractures that occurred after passing over speed humps while in a motor vehicle, from January 1, 1997 to April 30, 2008 in the Hospital del Trabajador de Santiago, Chile. RESULTS: Of a sample of 46 patients with 52 fractures-none of them with neurologic impairment-37 female patients (80.4%) and 9 male patients (19.6%) with an average age of 48.5 years (16 to 70 y), 67.4% (31 of 46) presented comorbidities. Six patients presented 2 spine fractures, all of them at adjacent levels. Forty-four individuals (95.7%) were injured in a bus: 42 of 44 patients (95.5%) were seated on the last row, whereas the remaining 2 patients were bus drivers. All patients had type A Association for Osteosynthesis/Association for the Study of Internal Fixation fractures, 30/52 (57.7%) subtype A1 and 20/52 (38.5%) subtype A3. L1 was the most frequently fractured vertebra (23/52, 44.2%), followed by T12 (11/52, 21.2%). Ten patients (21.7%) required surgical treatment. The average time out of work was 104.3 days; 3 patients (6.5%) received workers' compensation for chronic lumbar pain. The mean follow-up time was 78.6 months (24 to 159). CONCLUSIONS: Seating in a motor vehicle, particularly on the last row in a bus, as it passes over a speed hump may cause severe traumatic spine injuries. These fractures occur more frequently at the thoracolumbar junction and treatment may require surgery.