Sacral fractures in dogs: a review of 32 cases

Abstract

Sacral fractures have not been described well in dogs. The records of 32 dogs diagnosed with sacral fractures were evaluated for neurologic deficits at presentation and discharge. Follow-up was in the form of telephone survey or physical examination at recheck. A score was assigned for each dog at presentation, discharge, and follow-up (0 for normal, 1 for minor deficits, and 2 for major deficits). Fractures located lateral to the sacral foramina were called abaxial, and those medial to the sacral foramina were called axial. Axial fractures had significantly more severe deficits at presentation (p = 0.00017) and discharge (p = 0.03063), but not at follow-up. Neurologic status did not improve significantly during hospitalization in either fracture group, but had improved significantly at follow-up.

Repair of sacral fractures using pins and polymethylmethacrylate (six cases)

“…Stabilisation of vertebral fractures with pins and PMMA has been previously documented in the literature and L7–S1 composite fixation has been described for the stabilisation of L7 fractures and degenerative lumbosacral disease . However, in the comparatively small body of veterinary work pertaining to sacral fractures, most work has focussed on classification of fracture configuration . Previous cases series have presented the use of lag screw fixation, trans‐sacral pins or a trans‐ilial locking plate, but to the author's knowledge this is the first description of a composite repair technique for sacral fractures.…”

“…Historically, the most commonly used technique for sacral fracture fixation in veterinary surgery has been the iliosacral lag screw . When used for simple longitudinal or oblique fractures, the inherent stability and interfragmentary compression created by one or two lag screws is anticipated to result in predictable primary bone healing.…”

“…Kuntz et al defined abaxial fractures as those located lateral to the sacral foraminae or involving the median sacral crest and axial fractures as those medial to the sacral foraminae and ventral to the median sacral crest. 3 Axial fractures have been shown to be associated with a higher incidence of neurological dysfunction. 3 Anderson et al developed a more exhaustive classification scheme based on fracture configuration.…”

“…3 Axial fractures have been shown to be associated with a higher incidence of neurological dysfunction. 3 Anderson et al developed a more exhaustive classification scheme based on fracture configuration. 4 They proposed five fracture types (Figure 1), with type I essentially a sacroiliac luxation with an associated partial sacral wing avulsion fracture, type II as longitudinal or oblique through one or both sacral foraminae, type III as transverse, type IV as avulsion of the sacrotuberous ligament and type V as comminuted.…”

“…The most widely used method of surgical stabilisation is an iliosacral lag screw, typically for fixation of unstable type I and type II sacral fractures, similar to routine sacroiliac luxation repair. 3,5,6 However, without the use of intraoperative fluoroscopic guidance, the previously elucidated safe corridor for sacral implants can be easily missed, resulting in suboptimal implant placement. 6 The absence of the recognised anatomical landmarks for lag screw placement located on the sacral wing in type II sacral fracture fixation can also hamper ideal implant placement.…”