[A propos of an unusual case of lumbar-pelvic dislocation in a suicidal jumper]

Abstract

Purpose of the study: We report a particular case of lombo-pelvic dislocation in a suicidal jumper, characterized by a distal sacral fracture associated with bilateral fractures of both iliac wings. To our knowledge, it has yet not been described.

Material and methods: The patient was a 27 years old individual. On admission, he sustained the following injuries: hemodynamic shock with intraperitoneal bleeding due to disruption of the triangular ligament of the liver, which resolved with blood transfusions and did not require surgical treatment pelvic fractures initially identified as transverse fractures of both iliac wings, with bilateral avulsions of sciatic spines a compression fracture of the first lumbar vertebra without neurologic complication. In the intensive care unit, evolution was favorable. However, an incomplete cauda equina syndrome was noticed: the anal sphincter was flacid but perianal sensation to pinprick was conserved. An electromyogram showed that the latence of perineal reflexes was increased. The fracture and its displacement were recognized secondarily. A pelvic C.T. exhibited an increases in the antero-posterior dimension of the pelvic ring, due to a distal-displaced transverse sacral fracture. The proximal fragment of the sacrum remained attached to the iliac wing since sacro-iliac joints were intact, iliac wings had tilted forward, and the distal tip of the proximal sacral fragment was driven backward and inferiorly.

Results: The patient was maintained in the supine position during 3 months. He then rapidly recovered normal function of his lower limbs. He had normal gait patterns and pelvic static. He did not complain of any pain. Finally, the neurological deficit disappeared and he regained full sexual function and complete control of micturition.

Discussion: We think that this fracture should be considered as a variety of suicidal jumper's fracture described by Roy Camille et al. It has the same displacement as type 2 fracture in Roy Camille classification. In the emergency room, diagnosis is difficult, based on usual AP pelvic roentgenograms. A bilateral fracture of iliac wings in a suicidal jumper, especially if associated with bilateral sciatic spine avulsions, is an indication to a pelvic C.T.. A neurological perineal deficit should be ruled out. In our case, the perineal deficit can be attributed to the stretching of sacral roots resulting from a posterior displacement of the sacrum. The favorable evolution suggests that surgery may be not required, and there is no evidence in the literature that it would help neurological recovery. In distal fractures, the sacral canal is not narrowed, and a sacral laminectomy appears therefore not indicated.

Conclusion: We have described a particular type of transverse fracture of the pelvis, which, in our mind, should be put in the same category as type 2 transverse fractures of the sacrum described by Roy Camille and al, in the suicidal jumper. Since there is no compression of sacral roots into the sacral canal, prolonged bedrest is likely to be the better treatment.