E-Case report
Sacral Fracture H-type, C3Stefan Lauinger, MD
![Dr-Stefan-Lauinger-case](https://neo-medical.com/wp-content/uploads/2023/01/Dr-Stefan-Lauinger-case.png)
Pre OP
![Vector](https://neo-medical.com/wp-content/uploads/2021/01/Vector-3.png)
Clinical Case – Sacral Fracture
H-type, C3
Stefan Lauinger, MD
Orthopaedic & Trauma surgeon
Klinik für Unfallchirurgie und Orthopädie
Klinikum Itzehoe
Itzehoe, Germany
![Klinium Itzehoe logo](https://neo-medical.com/wp-content/uploads/2023/01/Klinium-Itzehoe-logo.png)
![Rectangle-13](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-13.png)
![Stefan-lauinger](https://neo-medical.com/wp-content/uploads/2023/01/Stefan-lauinger.png)
![Rectangle-11](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-11.png)
![Rectangle-10](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-10.png)
Patient Information
This female patient, 73yo, BMI 22.5 (154cm, 55kg) suffered a sacral fracture (H-type, C3) after a fall from the rim of the bathtub.
She was treated by a general practitioner with pain medication. 19 days later treated in outpatient department without a correct diagnosis. After another 3 days she was admitted to hospital due to increasing pain (VAS 8).
Indication: Sacral fracture with spinopelvic instability
Other pathological conditions: Old fractures in 3 vertebral levels
Comorbidities: Art HT, osteoporotic bone quality (medication)
Risk factor: ASA 2
The patient had experienced no previous orthopaedic/spine surgery
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b-1.png)
![Rectangle-14](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-14.png)
![pro-op-1-lauinger-case](https://neo-medical.com/wp-content/uploads/2023/01/pro-op-1-lauinger-case.png)
Pre OP radiographs,
frontal and sagittal views
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
Pre OP CTs in different planes confirm the sacral fractures
![pro-op-2-lauinger-case](https://neo-medical.com/wp-content/uploads/2023/01/pro-op-2-lauinger-case.png)
![ligne-2b-1-reverse](https://neo-medical.com/wp-content/uploads/2022/01/ligne-2b-1-reverse.png)
![Rectangle-14](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-14.png)
Pre OP MRI stir sequence
The surgery was planned for spinopelvic stabilization of levels L5 – Ilium to be fused.
General anesthesia ITN.
Mini-open access spina iliaca post to L5 on both sides.
![pro-op-3-lauinger-case](https://neo-medical.com/wp-content/uploads/2023/01/pro-op-3-lauinger-case.png)
![Rectangle-10](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-10.png)
Intra OP
![ligne](https://neo-medical.com/wp-content/uploads/2021/02/ligne-e1613577992934.png)
Surgical Procedure
The surgery was planned for spinopelvic stabilization of levels L5 – Ilium to be fused.
General anesthesia ITN.
Mini-open access spina iliaca post to L5 on both sides.
![intra-op-1-lauinger-case](https://neo-medical.com/wp-content/uploads/2023/01/intra-op-1-lauinger-case.png)
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b.png)
![Vector](https://neo-medical.com/wp-content/uploads/2021/01/Vector-3.png)
![Rectangle-13](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-13.png)
![intra-op-2-lauinger-case](https://neo-medical.com/wp-content/uploads/2023/01/intra-op-2-lauinger-case.png)
![Rectangle-11](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-11.png)
Neo Pedicle Screw System™ was used for the posterior construct including iliac connector.
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
Ilium: 2 x Iliac screws Ø8.0 x 100mm, polyaxial
![intra-op-3-lauinger-case](https://neo-medical.com/wp-content/uploads/2023/01/intra-op-3-lauinger-case.png)
![ligne-2b-1-reverse](https://neo-medical.com/wp-content/uploads/2022/01/ligne-2b-1-reverse.png)
![Rectangle-14](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-14.png)
Level L5: 2 x Ø8.0 x 50mm
![intra-op-4-lauinger-case](https://neo-medical.com/wp-content/uploads/2023/01/intra-op-4-lauinger-case.png)
![Rectangle-10](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-10.png)
Iliac connectors, 40mm and 70mm (shortened by about 15mm), parallel connectors
2 x 60mm titanium pre-bent rods to achieve a force control fixation.
![intra-op-5-lauinger-case](https://neo-medical.com/wp-content/uploads/2023/01/intra-op-5-lauinger-case.png)
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b-1.png)
Post OP
Post OP result
- Intraoperative blood loss: 200ml
- Duration of surgery was 72 minutes
- No complications occurred postoperatively
- Hospital stay was 15 days, the prolonged hospital stay was due to a challenging situation at home with stairs and steps
- Rehab in outpatient clinic
- Post OP pain score (VAS):
- Back pain: 3
- Leg pain: 0
- Intact neurological status
Post OP Radiographs,
frontal and sagittal views
![post-op-1-lauinger-case](https://neo-medical.com/wp-content/uploads/2023/01/post-op-1-lauinger-case.png)
![ligne-2b-1-reverse](https://neo-medical.com/wp-content/uploads/2022/01/ligne-2b-1-reverse.png)
![6-month](https://neo-medical.com/wp-content/uploads/2023/02/6-month.png)
6 months Follow Up
Radiographs, frontal and sagittal views at 6 months postoperatively
- Pain score at 6 months FU (VAS): 1
- No pain medication needed
- The patient can move without assistance
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b-1.png)
Published with the approval of Dr. Stefan Lauinger, MD