RESUMO
INTRODUCTION AND IMPORTANCE: A fracture-dislocation of the vertebral bone is mostly caused by high-energy trauma. Spondyloptosis is the severest form of spondylolisthesis (>100 %) which affects the sagital or coronal plane from the contiguous vertebral bone. Anterior spondyloptosis is known as fracture-dislocation where the proximal part of the vertebra is located infront of the distal vertebrae. Most cases are associated with spinal cord injury (SCI) and unstable hemodynamics, in this case the vital sign of the patient's tend to be stable. CASE PRESENTATION: A 21-year-old man had multiple traumas after having a traffic injury, pain and numbness were positive during physical examination, especially in both lower limb. A radiography examination shows that the patient had total spinal cord transection and anterior spondyloptosis in T12 until L1 segment. Additional examinations found minimal renal and liver contusion including the ischemic bowel. The interbody fusion procedure was chosen as our therapeutic modalities. CLINICAL DISCUSSION: We performed open surgical methods by using interbody fusion modalities usually in patient's with stable vital signs. This intervention could be the priority in managing patients with a rare case of anterior spondyloptosis. A visual analog Scale (VAS) was used for monitoring the degree of pain, and Oswestry Disability Index (ODI) questionnaire for evaluating the outcome for low back pain. CONCLUSIONS: Most traumatic spondyloptosis cases end with neurogenic shock, Due to the injury's rarity and collaborated with minimal soft tissue injury, early diagnosis and the use of an open surgical method may improve patient's outcome.
RESUMO
INTRODUCTION AND IMPORTANCE: A fracture associated with an anteriorly displaced fragment may induce soft tissue disintegration. However, this might be avoided by maintaining the stability of the sacrococcygeal bone. Fixation by using less invasive modalities is needed to improve the outcome. CASE PRESENTATION: A 37-year-old female came with tailbone pain, which lasted around one month. There was a history of falling in a sitting position a month before hospital admission. Tenderness was positive while palpating the perineal site. A radiography examination shows a fracture in the sacrococcygeal segment with anterior dislocation. The patient was diagnosed with a sacrococcygeal fracture and anterior dislocation. CLINICAL DISCUSSION: We performed a mini-open procedure using a modified figure-of-eight technique to reconnect the sacrococcygeal bone. Suturing was performed through the skin in the painful area, and then the bone at the injured site was reduced. As an outcome, there was an improvement in the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and EuroQol-5 Dimensions (EQ5D) scores. CONCLUSION: A mini-open procedure with a modified figure of eight is a simple and valuable method for correcting the sacrococcygeal components.
RESUMO
INTRODUCTION AND IMPORTANCE: Ipsilateral proximal, shaft, and distal femur fractures are extremely uncommon. It might be challenging and contentious to treat ipsilateral multi-level femur fractures. There are still unanswered questions regarding the order of fracture types that should be repaired first and the type of implant that should be used. CASE PRESENTATION: A twenty-nine-year-old male patient was assessed at the emergency department after a motorcycle accident. The patient had a clearly deformed left lower extremity and was complaining of pain in the left thigh. Preoperative radiographs revealed ipsilateral multi-level femur fracture on the left thigh involved basicervical fracture of femur (AO/OTA 31-B3) with transverse shaft fracture of femur (AO/OTA 32-A3) and extra articular supracondylar femur fracture (AO/OTA 33-A2). CLINICAL DISCUSSION: First, we performed proximal femur nail antirotation in order to stabilize the fracture of the femur neck and reduce the incidence of nonunion and avascular necrosis of the femoral head in young adults. The next step to fix the shaft and distal femur fracture was to perform the distal femur locking plate. The EQ5D and Harris Hip Score questionnaires showed improvement after implementing these procedures. CONCLUSION: Ipsilateral multi-level femur fractures have challenges and controversies in their management. In this situation, proximal femur nail antirotation and distal femur locking plates are viable options due to the condition of the injury and the higher risk of negative effects. After all fractures have been fixed, it is important to closely monitor the hip and knee joints to avoid stiffness or contracture.
