Anterior Sacroiliac Dislocation

Abstract

I njuries to the sacroiliac joints are most commonly caused by high-energy trauma. Orthopaedic traumatologists frequently treat sacroiliac dislocations and fracture-dislocations as part of the spectrum of pelvic ring injuries. Typical sacroiliac joint dislocations are posterior; anterior dislocations are extremely rare. As with posterior dislocations, these are highenergy injuries with concomitant visceral, neurologic, and other osseous injuries. We describe a case of anterior sacroiliac dislocation that was treated with a closed reduction and percutaneous fixation in a trauma patient with multiple injuries.The patient was informed that data concerning the case would be submitted for publication, and she provided consent. Case ReportA twenty-one-year-old unrestrained driver was involved in a head-on collision with a tree at an unknown speed after reportedly attempting to avoid pedestrians in the road. She was initially evaluated in Mexico and was transferred to our level-I trauma center twelve hours after the accident.On admission to the trauma bay, the initial vital signs were blood pressure of 122/70 mm Hg, heart rate of 94 bpm, respiration of 24 bpm, and oxygen saturation of 100% on 2 L per nasal cannula. The initial hemoglobin and hematocrit levels were 10.9 g/dL and 31.6%, respectively. On examination, the patient was alert and oriented with a Glasgow Coma Scale score of 15. The spine was nontender, but she did have tenderness to palpation in the left sacroiliac region with accompanying ecchymosis posteriorly. The pelvis was unstable with lateral and anteroposterior compression.The patient had complete loss of sensation and motor function of the left lower extremity, although she had normal peripheral pulses in all four extremities. Perineal examination revealed no open wounds; however, there was left labial swelling and ecchymosis. A Foley catheter had been placed prior to arrival, and gross blood was identified in the urine. The stool guaiac test was negative, and there was minimally decreased rectal tone. There was a 5-cm laceration over the proximal part of the left tibia, a laceration on the posterior aspect of the right thigh, a 5-cm laceration overlying a fracture of the fifth metatarsal on the left foot, and multiple areas of tenderness and ecchymosis throughout the body.Initial radiographs and computed tomography (CT) scans demonstrated severe pelvic injuries, including a right posterior crescent fracture-dislocation, a left complete anterior sacroiliac joint dislocation, left superior and inferior pubic rami fractures, and L1-L5 transverse process fractures (Figs. 1-A through 1-D). Other orthopaedic injuries included a severely comminuted right tarsometatarsal fracture-dislocation, medial cuneiform and navicular fractures, a left type-2 open tibial plateau fracture, and a left type-2 open fracture-dislocation of the fifth metatarsal.Other than right-sided pulmonary contusions and a nonoperative extraperitoneal bladder rupture, the patient had no other noteworthy nonorthopaedic injuries, including b...

Multi-body 3D–2D registration for image-guided reduction of pelvic dislocation in orthopaedic trauma surgery

“…In addition, errors in 3D bone model definition arising from ASM segmentation errors could result in local minima, especially in the out-of-plane direction for cases of limited depth resolution. The overall TRE exhibited median of 2.5 mm (1.5 mm IQR), within reasonable accuracy for orthopaedic surgical applications (Smith et al 2005, Shillito et al 2014.…”

“…SPM CC target reduction estimation and 3D-2D registration guidance yielded median error of 2.3 mm and 0.3 mm in the simulation study, respectively. The overall reduction error, combining the two sources of error is well below the acceptable range (<4 mm) suggested in Smith et al (2005), Shillito et al (2014).…”

“…For each case, 0 mm on the horizontal axis represents initializing the 3D model at the ground truth location, and the dashed horizontal line indicates 4 mm translational error. In this work, the capture range was defined as the range of initialization error in which registration error was below 4 mm (consistent with residual errors above which long-term prognosis of complications is poor (Smith et al 2005, Shillito et al 2014). The in-plane capture range (x, z) of registration was measured to be around ±50 mm, beyond which the method did not reliably converge to the correct solution due to image gradients moving out of the radiographic scene.…”

“…Accurate reduction is challenged by the difficulty in reckoning the pose of complex 3D pelvic anatomy from 2D fluoroscopic projections, resulting in extended fluoroscopy time and frequent trial-and-error even for experienced trauma surgeons. In addition, residual displacement after reduction surgery (>4 mm) is associated with long-term complications such as persistent pain, limb length discrepancy, and disability (Smith et al 2005, Shillito et al 2014.…”

Đặc Điểm Hình Ảnh Tổn Thương Giải Phẫu Gãy Xương - Sai Khớp Cùng Chậu Trên Phim Ct- Scan Có Dựng Hình 3d Khung Chậu

“…Sau đó các trường hợp SKCC ra trước cũng được ghi nhận riêng lẻ trong các báo cáo ca ở cả người lớn và trẻ em. Tuy nhiên, năm 2014, Shillito và cộng sự hồi cứu y văn cho thấy tính đến thời điểm đó chỉ ghi nhận 4 trường hợp SKCC ra trước trên toàn thế giới và 6 trường hợp trẻ em và hầu hết các báo cáo trước đây đều mô tả sự cần thiết của phẫu thuật nắn chỉnh mở đối với các trường hợp GX -SKCC ra trước [11].…”