Abstract
Introduction: L5/S1 injuries can be associated with pelvic fracture but unfortunately they are often missed. Left untreated these patients may suffer disabling lower back pain. Our goal is to study the frequency of these injuries in pelvic fractures treated at this institution, thereupon to determine how many are missed and the outcome if this injury is treated conservatively. We will describe the radiological findings, anatomical features and possible surgical treatments.
Materials and Methods: A retrospective analysis was undertaken of pelvic fractures treated at this institution from 2000 onward. Outcome scores were taken from the patient records. All CT scans and x-rays were scru-tinised for a Lumbosacral Junction Injury(LJI). Numbers missed were tallied against numbers diagnosed and treated. Patient outcome measures were compared using the Matta Hip Scores. It was noted whether low back or hip pain contributed to their symptoms most.
Results: The incidence of lumbar sacral injuries associated with vertical shear pelvic fractures was 20%. Of these, 75% had not been identified as a specific lumbar-sacral injury. The remaining 25% which were identified and treated with fixation of the lumbar sacral junction had an excellent result. We have identified specific morphology patterns and propose a CT based grading system.
Discussion: We suggest that a heightened level of awareness is needed for these important injuries in pelvic trauma as their occurrence changes the management. The incidence appears to be higher than that reported by Isler and suggest our CT based classification be used to grade these injuries.
Correspondence should be addressed to: Dr Caroline Goldberg, The Research Centre, Our Lady’s Children’s Hospital Crumlin, Dublin 12, Ireland.
