Kenawey Mohamed, Addosooki Ahmad
Orthopaedic Department, Faculty of Medicine, Sohag University, Sohag, Egypt.
J Pediatr Orthop. 2014 Jul-Aug;34(5):e6-e11. doi: 10.1097/BPO.0000000000000139.
U-shaped sacral fractures or Jumper's fractures are rare injuries in adults and are even rarer in the pediatric population. These fractures share a common pathoanatomy where the pelvis as a unit together with the bilateral alar parts and the lower part of the sacrum, loses its skeletal and soft tissue connections to the remaining axial skeleton and hence the term spinopelvic dissociation. This report describes an unusual pattern of spinopelvic dissociation in a young child where the transverse process of the fifth lumbar vertebra was avulsed on one side (spinal side avulsion), whereas on the other side, complete iliac crest apophyseal avulsion took place (pelvic sided avulsion). To our knowledge, this combination of injuries was not reported before. The available literature describing pediatric U-shaped sacral fractures were also reviewed to help explain the pathoanatomic basis of this association.
An 8-year-old boy sustained a U-shaped sacral fracture with avulsion of the left iliac crest apophysis. A search in the English literature was performed for all reports of U-shaped sacral fractures in pediatric patients (≤ 18 y of age), as well as the relevant literature, which describes the pathoanatomy, possible radiologic findings, and current classification systems and treatment options.
Fixation using a 7.3 mm percutaneous iliosacral screw was performed. At the latest follow-up, the child had no pain, was fully bearing weight on lower extremities, and was neurologically intact. The literature review yielded 6 other pediatric patients with U-shaped sacral fractures in 4 articles.
In young children with immature pelvis, the iliac apophysis may be avulsed instead of the transverse process of the fifth lumbar vertebra by forces transmitted through the iliolumbar ligament. The apophysis will therefore keep its attachment to the abdominal and trunk muscles, whereas the bony iliac wing and the pelvis would be dissociated from the axial skeleton. Otherwise, the pathoanatomy of these injuries is the same as described in adults.
Level IV.
U 形骶骨骨折或跳跃者骨折在成人中较为罕见，在儿童群体中更是罕见。这些骨折具有共同的病理解剖结构，即骨盆作为一个整体，连同双侧翼部和骶骨下部，与其余轴向骨骼失去骨骼和软组织连接，因此称为脊柱骨盆分离。本报告描述了一名幼儿中一种不寻常的脊柱骨盆分离模式，其中一侧第五腰椎横突撕脱（脊柱侧撕脱），而另一侧发生了完全的髂嵴骨骺撕脱（骨盆侧撕脱）。据我们所知，这种损伤组合以前未曾报道过。还对描述小儿 U 形骶骨骨折的现有文献进行了综述，以帮助解释这种关联的病理解剖学基础。
一名 8 岁男孩发生了伴有左侧髂嵴骨骺撕脱的 U 形骶骨骨折。检索了英文文献中所有小儿患者（≤18 岁）U 形骶骨骨折的报告以及相关文献，这些文献描述了病理解剖结构、可能的影像学表现、当前分类系统和治疗选择。
采用 7.3 毫米经皮髂骶螺钉进行固定。在最近的随访中，患儿无疼痛，下肢完全负重，神经功能完好。文献综述在 4 篇文章中发现了另外 6 例小儿 U 形骶骨骨折患者。
在骨盆未成熟的幼儿中，通过髂腰韧带传递的力量可能导致髂嵴骨骺而非第五腰椎横突撕脱。因此，骨骺将保持其与腹部和躯干肌肉的附着，而髂骨翼和骨盆将与轴向骨骼分离。否则，这些损伤的病理解剖结构与成人中描述的相同。
四级。
