Open fracture of the sacrum in a fall from a fifth floor

Abstract text (incl. references and figure legends)

Case history

A 17-year-old male with open sacral fracture due to precipitation from a fifth floor.

Clinical findings

On examination, the patient presented an open wound with a sacral fracture and significant loss of substance.

Investigation/Results

CT scan showed L2 vertebral body fracture with retropulsion of the posterior wall, complex fracture of the sacrum with a posterior displacement of 4 cm and bone exposure throught skin defect later and large retroperitoneal hematoma.

Diagnosis

Complex fracture of the sacrum Gustilo IIIC.

Therapy and progressions

Orthopedic and General surgeons intervened for unloading colostomy and peritoneal packing with Friedrich of the sacral wound. Repeated surgical washes were required in the following days until definitive surgery, which involved a sacral plate and subsequent spinopelvic fixation L1-L5. Subsequent coverage was performed with a gluteal rotation flap. The patient suffered from several surgical site infections during his admission, for which it was required antibiotic therapy. He was later discharged to a paraplegic center. Al the present time, he has currently regained full strength in his hips and knees, although paresis of his ankles and feet persists and it is pending the performance of a self-catheterization due to sphincter alteration.

Comments

The main cause of sacral fractures in young people is high-energy trauma and it may be associated with neurological deficits. Open fractures are a challenge due to the possibiliy of infection and the complexity of coverage. In caso co concomitance with a lumbar fracture, it is recommended the association of spinopelvis fixation and posterior tension band plating.

References

Rodrigues-Pinto R, Kurd MF, Schroeder GD, Kepler CK, Krieg JC, Holstein JH, Bellabarba C, Firoozabadi R, Oner FC, Kandziora F, Dvorak MF, Kleweno CP, Vialle LR, Rajasekaran S, Schanke KJ, Vaccaro AR. Sacral fractures and associated injuries. Global Spine J. 2017 Oct;7(7):609-616.

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