SUICIDAL JUMPER’S FRACTURE OF THE LUMBO-SACRAL SPINE – RECOMMENDATIONS FOR OPERATIVE STABILISATION

Abstract

Introduction: Bilateral and transverse fractures of the first two sacral vertebrae with intrapelvic intrusion of the lumbo-sacral spine are very rare injuries. In most cases the lesion occurs after a fall from great height in a kyphotic position when landing. Today’s CT-scans in these mostly polytraumatized patients enable a clear diagnosis. In contrast conventional radiographs have a high risk to ignore these fractures. Operative treatment requires proper reduction and secure fixation which so far is not unrestricted possible using recommended techniques. For reduction lumbo-sacral distraction followed by lordotic extension is essential but difficult to obtain. Therefore we modified the lumbo-pelvic instrumentation to facilitate these requirements.

Methods: In the last four years we treated three female patients (aged 27–68 years) as follows: Variable axis screws (VAS – Synthes®) were inserted in the L4 and L5 pedicles and connected with two connecting rods. An additional variable axis screw was inserted in each posterior iliac spine. These both screws were connected with a transverse connecting rod situated over the transverse fracture line. This rod was connected with the two upright rods using a rod-to-rod connector and forming a hinged joint. Due to the not tightened nut of the pedicle screws at that time it was possible to spread the lumbo-sacral fracture line. After tightening of the lumbar screws the upper part of the body was slightly elevated resulting in a lordotic extension in the hinged joint. Subsequently the hinged joint was locked (Video).

Results: Postoperative CT scans revealed anatomic reduction and properly inserted implants in all cases. Follow-up was uneventful but a heparin related thrombopenia in one patient. Two patients were mobilized under full weight bearing within 4 and 10 days, respectively. In one cases this was not possible because of relevant foot fractures. Neurological deficits completely resolved in one patient within fourteen days and markedly diminished in another patient within months (persistent neuralgia). In one patient no neurological deficit existed. In all cases a complete hardware removal was done in 8 to 11 months.

Conclusions: The presented procedure is suitable for the so-called jumper’s fractures and results in anatomic reduction of the displaced fractures and a secure stabilization. The described hinged joint offers effective lordotic extension which is the key point for reduction. Thus this configuration is a reduction as well a fixation device. Full weight bearing in an erect posture is immediately possible and clearly shorten the rehabilitation period.