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43 yo female p/w lower back pain s/p fall in ice skating rink 2 hours PTA.
No other complaints
History and PhysicalT 98.0 P 107 BP
147/83 O2 99%Gen: WDWN, mild
acute distressCV: Tachycardic, RR,
no m/r/gPulm: Lungs CTA bilatBack: PTTP lower
lumbar/sacral regionExt: Left foot drop
with L5 distribution paresis
Stable fx:Outpt Orthopedic f/u in 1-2 wks
Unstable fx:Emergent Orthopedic c/s
Neurological DeficitEmergent Orthopedic c/s
ED Management
Follow 3 arcuate lines (foramen)Disruption= significant pathology
L5 TP frx without illiac crest frx, suggest occult sacral frx
StabilityStable:
impacted vertical fracture of sacrum, nondisplaced fracture of posterior sacroiliac complex; or subtle fracture of upper sacrum as seen by
Unstable:diastasis of more than 0.5 to 1 cm, along w/ an
unstable anterior injury
Pearls
Type 1frx at sacral ala L5 nerve root; ~6% with
neurological injuriesType 2
Frx at neuroforamina unilateral sacral anesthesia; Tx: operative debridement of frx fragments prior to
reduction
Type 3frx thru body cauda equina + neurogenic bladder;
~56% with neurological injuries
Pearls
Perform DREFor S1 nerve root involvementif bloody Open sacral fracture
Fractures a/w:Anterior pelvic frxThorough neuro exam
Pearls
R Sakakibara1, T Uchiyama1, C Yamaguchi2, et al. Spinal Cord (2007) 45, 790–792; doi:10.1038/sj.sc.3102058; published online 27 March 2007
http://www.imageinterpretation.co.uk/pelvis.html
http://www.wheelessonline.com/ortho/sacrum_and_sacral_fractures
Simon, Robert, and Scott Sherman. Emergency Orthopedics. New York: McGraw Hill, 2011. 6th Ed.
References