A Case Report of a Vertical Zone III Sacral Fracture Due to Acute Lower Extremity Hyperabduction While Windsurfing.

Typically associated with motor vehicle accidents and falls, sacral fractures result from sudden compression of the iliac wings, placing bidirectional traction forces on the anterior and/or posterior aspects of the sacrum. Here we describe a vertical Zone III sacral fracture caused by sudden, forceful hyperabduction of the lower extremities. To the authors' knowledge this is the first report of a Zone III sacral fracture caused by this mechanism which occurred when the patient encountered a large wave while windsurfing. Imaging revealed a longitudinal fracture to the anterior sacrum, with a concomitant Zone II fracture and pubic symphysis diastasis. The patient was treated using anterior fixation plating and posterior percutaneous pinning. The purpose of this study is to increase provider awareness of an often underdiagnosed fracture, alert water sports enthusiasts of the risks associated with windsurfing, describe signs and symptoms of this often overlooked fracture, and discuss treatment modalities based on radiographic and clinical assessments of fracture stability.

Short same-segment fixation of thoracolumbar burst fractures.

INTRODUCTION: Minimizing the number of vertebral levels involved in fusion of a spine fracture is a common goal of internal fixation. This is achievable by utilizing traditional short-segment posterior fixation (SSPF). However, in SSPF there is reported up to a 54% incidence of instrument failure or unfavorable clinical outcome. Short-segment posterior fixation with pedicle fixation at the level of the fracture (short same-segment fixation) suggests biomechanical advantages toward maintenance of kyphosis correction and reducing failure rates. However its clinical efficacy is largely unknown. METHODS: The team conducted a retrospective review of 25 thoracolumbar burst fracture patients who were treated with short same-segment fixation between September 2005 and April 2009. The primary outcome measure was incidence of reoperation and loss of kyphosis correction within the follow-up period. Long-term functional status and pain was also assessed. RESULTS: Average duration of the most recent follow-up was 21.64 months (range 3 to 42 months). Two patients (8%) required reoperation due to either hardware failure or pseudoarthrosis. Mean pre-operative kyphosis was 14.49°. Average post-operative kyphosis was -0.74° (lordosis). Average follow-up kyphosis of all cases was 10.78°. Excluding failures, average follow-up kyphosis was 8.67°. A mean of 15.23° of kyphosis correction was attained from pre-operation to post-operation (P < 0.0001). Average loss of kyphosis correction from immediate post-operation to most recent follow-up was -11.51° and -9.51 excluding the two failures (P < 0.0001). Average pre-operative to most-recent follow-up kyphosis correction was 3.72° (P = 0.067) and 5.51° excluding failures (P = 0.0024). At initial one-month follow-up, average disability score was 52.63% (range 16% to 84%). At most recent follow-up, average disability score was 5.5% (range 0% to 16%). One patient was lost to long-term follow-up. Mean difference from one-month follow-up to most recent follow-up (excluding failures) was 47.27% (P < 0.0001). CONCLUSIONS: Short same-segment fixation decreases implantation failure rate and reoperation rate compared to traditional SSPF, however long-term kyphosis correction was not maintained. Despite this loss of kyphosis correction, clinical pain and disability improved at long-term follow-up.