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Case Reports
. 2018 Jun 26;12(1):186.
doi: 10.1186/s13256-018-1668-1.

Suicidal jumper's fracture - sacral fractures and spinopelvic instability: a case series

Daniela Nonne  1 , A Capone  2 , F Sanna  2 , L Busnelli  2 , A L Russo  3 , G Marongiu  2 , G Dessì  3 , A Ferreli  3
Affiliations
Case Reports

Suicidal jumper's fracture - sacral fractures and spinopelvic instability: a case series

Daniela Nonne et al. J Med Case Rep. .

Abstract

Background: Sacral fractures with spinopelvic dissociation are rare, and hard to diagnose and treat. Fractures with a H- or U-shaped line are severely unstable, due to a dissociation of the spine and of the upper body of the sacrum from the pelvis. They are commonly due to high-energy trauma events, with severe neurological injuries in 80% of cases.

Cases presentation: Five polytraumatized Caucasian patients, three women and two men (mean age: 34 years old) with spinopelvic dissociation were selected. All patients underwent level I-II examinations with radiographs and computed tomography total-body scans; all patients needed damage-control procedures. Sacral fractures were classified according to Denis and Roy-Camille classifications, and neurologic injuries of cauda equina according to Gibbons classification. Patients' outcome was analyzed with the Majeed score. Definitive surgical treatment was appropriate for two patients (lumbar-pelvic fixation or transverse bar). Clinical and radiographic outcomes were analyzed periodically. Four patients survived, all of them suffered severe neurologic deficits. One case of osteomyelitis was treated with the removal of the fixation implants 23 months after the accident.

Conclusions: Diagnosis of spinopelvic dissociation is frequently overlooked due to the severe associated injuries affecting these patients. In cases of a fall from high height, this lesion should be investigated with a lateral sacral radiographic view and computed tomography scan of the pelvis. If untreated, it can lead to severe and progressive neurologic deficit with muskuloskeletal deformities and persistent pain. Early decompression treatment is controversial, but an early lumbopelvic fixation is recommended. A correct diagnosis and early treatment can reduce morbidity and strongly improve the outcome of these patients.

Keywords: Decompression; Jumper’s fracture; Lumbopelvic fixation; Sacral fracture; Spinopelvic dissociation.

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Conflict of interest statement

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Our patients have signed terms of consent to participate in the research of these case reports. The institutional ethics committee has approved the publication of these case reports.

Consent for publication

Written informed consent was obtained from the patients for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Case report: woman, 48 years. a-b H-shaped line fracture of the sacrum (Roy-Camille type III) and spinopelvic dissociation; (c) spinopelvic fixation [2]; d-e radiographic follow-up after 22 months
See this image and copyright information in PMC

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