Category Archives: blog

Joint Stiffness

By  aenriquez  published  July 11, 2019

Are you suffering from stiff joints? If you are, many people will say “Welcome to the club.” This is because stiff joints is a common symptom for many conditions from a cold or the flu to specific joint diseases.  It is also extremely common for the elderly to complain of stiff joints, which are almost as predictable as needing bifocals when you turn 45. If you see an elderly person having trouble bending over, then having more trouble picking up an object from the floor, give them a hand. Those aches and pains are real.

There are two general observations about growing old that contribute to those aches and pains, including stiff joints. One is simple wear and tear on cartilage, bursa, vertebral discs and other mechanisms that help joints move. These structures allow for easy movement by providing a fluid-like cushion or a smooth surface for bones to move without having them grind together. Bursa, for example, acts like very tiny water balloons that are wedged into joints, allowing for smoother motion. Cartilage, meanwhile, covers the ends of bones where they terminate at joints, providing a smooth, resilient surface for the bones to slide on. When the cartilage wears out, it is extremely slow to heal, partly because cartilage does not have a blood supply.

When cartilage wears out, it is extremely slow to heal, partly because cartilage does not have a blood supply

The second reason behind stiff joints as you age is the lack of fluids. As we age, we become drier. While water content in our bodies is also dependent on age and weight (thinner people have less water than heavier people when we are infants, our average water content is 75 percent to 78 percent. As adults, this drops to 50 percent to 65 percent. This loss of water affects mechanisms like your vertebral discs. These compact spongy cushions become less spongy as we age. Part of the reason: They become drier.

Here are just some of the diagnosable conditions that can result in a stiff joint.

  • Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disorder characterized by pain in the wrists, fingers, hands, and feet. The immune system in this disease attacks the lining of your joints, which often creates painful swelling and stiffness.

  • Osteoarthritis

As opposed to rheumatoid arthritis, which is an autoimmune disorder, osteoarthritis is a wear and tear condition. As we age, the cartilage that protects the ends of our bones begins to wear out, resulting in bone against bone movement.

  • Bursitis

Bursitis is another wear and tear condition. Bursae are tiny sacks that give joints cushioned movement. However, when these become inflamed, the result is a painful condition called bursitis.

  • Lupus

Lupus is an autoimmune disorder that can result in painful joints, especially in the knees, wrists, and fingers. People who suffer from lupus have good days and bad days, as the pain is intermittent.

  • Gout

Gout, which generally starts in the joints of the big toe, is a painful condition that is grouped together with arthritis, which it resembles.

  • Fibromyalgia

This chronic pain condition is usually associated with muscle pain, but many patients experience stiff joints, as well.

  • Polymyalgia Rheumatica

This is a joint disease that is rarely seen in people under 50. It results in stiff joints, mostly in the shoulders, neck, hips, fingers, and wrists.

Make a call

Are you or anyone you know suffering from joint stiffness? Let us help you return to an active lifestyle with minimum pain. Call FXRX Orthopaedics and Bracing in Phoenix, Az., at 480-449-FXRX.

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Decompression Laminectomy

By  aenriquez  published  July 2, 2019

The decompression laminectomy operation is a common back surgery in which the doctor removes vertebral bone that is putting pressure on nerves. The back part of the vertebral bone is the part that is removed and the operation could entail removal of that portion of vertebral bone from more than one vertebra. Other painful conditions, like bone spurs, can also be addressed during decompression laminectomy surgery.

The surgery is considered a major operation that requires the use of general anesthesia delivered through a facial mask. Patients are also given a sedative to help them remain calm and to increase the general anesthesia’s effectiveness. During the operation, the patient lies on his or her stomach to allow access to the back. Patients are frequently intubated, which involves putting a plastic tube through the patient’s mouth, past the vocal cords to the windpipe. This allows doctors to have air pumped in and out of the patient’s lungs during the surgery. This is done with a mechanical ventilator.

Spinal surgery can be done from the front or the back, but a decompression laminectomy is done from the back

The Surgery Itself

Spinal surgery can be done from the front or the back, but a decompression laminectomy is done from the back. It starts with the surgeon making an incision above the area where the pain originates. After the incision is made, the surgeon then moves the muscle and soft tissue in order to have a view of the patient’s spine.

After the correct area of the spine is exposed, surgeons then cut away bone spurs and any ligaments that are pressing on nerves. The surgeon could also cut away substantial portions of vertebrae that have been causing the patient pain or discomfort or limiting flexibility.

Spinal Fusion

Along with the decompression laminectomy, the patient may have to undergo spinal fusion. This entails “welding” two vertebrae together by use of bone grafts – one or several – that allow the adjacent vertebrae to heal together as one bone. Sometimes, the surgeon elects to use metal plates, screws and rods to ensure that the vertebrae are stabilized.

A spinal fusion restricts flexibility the patient had before surgery, but the movement is often the source of the pain. The patient sacrifices some movement while finding relief from the pain presented by a herniated disc or other conditions.

When the surgery is complete, the surgeon sews the wound back together and the patient wakes up as the mask is removed and the intubations tube is taken out.

Recovery Time

Recovering from a decompression laminectomy can take a while, although many patients, with their doctor’s approval, find they can go home the same day the surgery is performed.  You will be instructed on how much activity you can take on until healing is complete.

Others are not so lucky. According to Spine-Health, 70 percent to 80 percent of patients who undergo this operation feel immediate relief, while others find relief is slower to arrive.

Risks

There are also risks with this surgery, just as there is with other major operations. In the case of decompression laminectomy, the risks include:

  • Nerve root damage – the odds are 1 in 1,000 of this occurring
  • Cerebrospinal fluid leak – odds are 1 percent to 3 percent, but recovery from this is usually under 24 hours if the patient remains lying down
  • Infections – 1 percent of cases, although usually this can be dealt with by the use of IV antibiotics.

 

Make A Call

Are you or anyone you know suffering from back pain? Let us help you return to an active lifestyle. Call FXRX Orthopaedics and Bracing in Phoenix, Az., at 480-449-FXRX.

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4 Common Injuries that require Urgent Orthopedic Care

By  david@ogrelogic.com  published  June 21, 2019

Orthopedic injuries that result in open fractures (fractures that break the skin) should rush to the nearest ER or call 911. But there are other orthopedic injuries that require urgent orthopedic care.

Knee Injuries

The knee is may suffer an injury even during walking. Most knee injuries are the result of a –

  • sudden change in direction (such as pivoting, shifting, jumping), or
  • sudden force (stepping down from a high surface, landing during a jump)

Any knee injury should be taken seriously and be seen by an orthopedic doctor. Common knee injuries include cartilage and ligament tears, sprains and strains.

Shoulder Injuries

Since the shoulder is one of the most mobile joints, it bears great force and rotation every day.  If the soft tissues, such as ligaments and muscles, of the shoulder are overused or overstressed, injuries may occur. Common shoulder injuries are rotator cuff tears, shoulder fractures, shoulder dislocations and injuries to the soft tissues.

Ankle Injuries

The most common ankle injury is a sprain. When the ankle is –

  • over inverted, such that the soles of the feet point inward, or
  • over everted, such that the soles of the feet point outward, or

the ligaments of the ankle joint suffer a sprain. Ankle sprains may vary in severity.

Wrist Injuries

Wrist injuries usually occur while landing on an outstretched arm during a fall. The wrist may suffer a strain that causes pain, swelling, bruising, and even numbness. A wrist fracture can also similar symptoms.

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Osteoporosis

By  aenriquez  published  June 18, 2019

Osteoporosis is a naturally occurring condition that becomes a health concern once people reach 50 years of age. It becomes potentially more serious the older they get. In fact, since bone mass peaks in your mid-20s, it can be said that the process of osteoporosis begins at that point. After that, as you age, your bones become less dense and weaker. The less dense your bones become, the higher your risk of a fracture.

Bones Are Living Tissue

Many people don’t realize that bones are living tissues that are undergoing constant change. Older cells reabsorb into the body, while new cells are created. At first, of course, your bones grow from the time you are born until you reach your late teenage years. After density peaks in your late 20s, bone strength is maintained through a process called remodeling. During this phase, your bones are still living tissue with old bone matrix reabsorbed into the body, while new formation is taking place.

Depending on your age, your general health and the severity of the injury, the time it takes to heal from a hip fracture can vary

As we age, bone formation continues, but at a pace, that is too slow to keep up with bone loss. This is the process of osteoporosis, which means “porous bone.” Certainly, porous bone is weaker and more prone to fractures and breaking.

Major Concerns

According to the International Osteoporosis Foundation, one in three women and one in five men over fifty years of age are at significant risk for an osteoporosis-related bone fracture. These commonly occur in the hip, the spine and the wrist with more serious consequences depending on the location. All fractures are serious, but the weight-bearing responsibilities of the hips and the spine make a fracture in those locations potentially life-altering.

Depending on your age, your general health and the severity of the injury, the time it takes to heal from a hip fracture can vary. Meanwhile, osteoporosis of the spine can lead to a compression fracture of vertebrae, which can be extremely painful. Left untreated, a vertebral compression fracture results in a condition called Dowager’s Hump, which is a characteristic posture that includes a rounded upper back and a neck tilted too far forward. In addition, a vertebral fracture often results in a lower height.

Diagnosis

While everyone past a certain age experiences osteoporosis – just as everyone past 40 years of age is a candidate for bifocals – when the condition becomes acute, you can be diagnosed with osteoporosis.

This is usually done with a physical at your doctor’s office. If need be, the doctor will then order a bone mineral density test (BMD). This is done with specialized imaging called a DXA, which stands for dual-energy X-ray absorptiometry. This is a low radiation X-ray that can identify small changes in bone density.

Your doctor will recommend one or more specialized DXA tests that focus on the forearm, finger and heel, the spine, the hip or your whole body.

Osteoporosis – essentially, acute osteoporosis – is diagnosed when someone has a T-score lower than minus 2.5. A score of minus 1 to minus 2.5 is labeled osteopenia, while a score lower than minus 2.5 is considered severe osteoporosis.

 

Treatment

 

While diet, exercise and the avoidance of tobacco and heavy alcohol use are recommended for preventing osteoporosis, there are medications available for people diagnosed with osteoporosis. These are:

 

  • Bisphosphonates
  • Denosumab
  • Selective Estrogen Receptor Modulators
  • Calcitonin
  • Strontium ranelate
  • Teriparatide
  • Hormone replacement therapy (HRT)

 

Procedures

 

For persons with compression fractures of a vertebral segment or segments, the procedure known as kyphoplasty is recommended. This procedure involves forcing the vertebrae back to its original shape with an inflating device, then removing the device and filling the empty space with special bone cement. This keeps the vertebral segment in the correct shape, restoring movement and relieving pain.

 

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Tommy John Surgery

By  aenriquez  published  June 12, 2019

When people think of major league baseball pitcher Tommy John, two things might pop into their minds. The first has to do with his baseball career, which was certainly an exemplary and enduring career that included a record (at the time) for a pitcher of 26 seasons in big league baseball. The second thing people associate with Tommy John is the surgery that bears his name.

 

John’s career included participation in three dramatic Worlds Series between the Los Angeles Dodgers and the New York Yankees. Twice he was voted as a baseball All-Star. But one statistic from his career has been the focus of speculation for many years, which is John’s pre-operation success on the pitcher’s mound and his post-operation success.

Any surgical procedure needs to be thoroughly discussed with qualified physicians, and elective surgery is not an exemption to that rule

Before And After Surgery

Prior to surgery, which took place in 1974, John had notched 124 victories as a major league pitcher. After taking a year off to recuperate, John returned in 1976 and from then on amassed 164 more wins. As such, the operation not only worked, but it gave rise to speculation that John threw the ball harder after the surgery than before.

 

John’s comeback from surgery was startling in its success and the pitcher’s longevity. And it wasn’t long before parents of healthy young baseball prospects were requesting the operation for their offspring, hoping the elective procedure would turn their child into a major league baseball player.

 

Buyer Beware

 

Any surgical procedure needs to be thoroughly discussed with qualified physicians, and elective surgery is not an exemption to that rule. Certainly, if you could buy a bionic mechanism that could turn your child into a baseball star, people would line up around the block to grab a hold of that slice of the American Dream. Only your physician and yourself can make the call on whether or not to go through with that option. Here, let’s discuss how the procedure works.

 

Ulnar collateral ligament reconstruction surgery

 

Recommended if the ulnar collateral ligament is frayed or stretched beyond healing, this reconstruction surgery was first performed on Tommy Johns by Dodgers team physician Frank Jobe. Technically, the procedure is a surgical graft. This entails replacing the damaged ligament with a tendon taken from a donor or from another portion of the patient’s body.

 

Needless to say, if the tendon is taken from the patient’s body, the physician selects one that will not have a major negative impact when removed. The tendons commonly used are the patellar tendon, which comes from a knee joint, or the palmaris tendon, selected from the opposite forearm.

 

The procedure involves drilling holes in the ulna and humerus bones of the elbow, then wrapping the donated tendon through the holes in a figure eight fashion. The ends of the tendon are then anchored in place. At times, the procedure also involves moving the ulnar nerve, which is made necessary if the new scar tissue is likely to push on the nerve causing post-operative pain.

 

Not Just for Pitchers

 

Pitchers are not the only baseball players prone to ulnar collateral ligament distress. The condition, however, is predominantly a baseball-specific injury. For pitchers, the recovery time is more significant for pitchers than for other players.

Meanwhile, the rise in ulnar collateral ligament procedures on youth – elective or not – has been on the rise, prompting Major League Baseball and Little League Baseball to encourage injury prevention pitching by following a program called Pitch Smart.

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Shoulder Replacement Surgery For Younger Patients

By  aenriquez  published  June 4, 2019

Shoulder replacement surgery – called a shoulder arthroplasty – has traditionally been relegated to helping elderly patients who suffer from long-term arthritis that is leading to the deterioration of cartilage and possibly bone structure. However, doctors now see advancements in both material and technique may allow the option to be extended to select younger patients. Let’s see if you are a candidate for this type of operation.

Structure

The shoulder is a ball and socket style joint with a design that is likely not quite what most people imagine. While many envision a ball and socket as a mechanism that includes a socket wrapping almost completely around a ball, the shoulder has a ball that simply rests against a slightly concave structure, held in place by muscles and a series of tendons and ligaments. Picture a round-bottomed cup resting against an almost flat saucer, held there by rubber bands. The saucer doesn’t wrap around the cup, it provides a settling place for it and, under normal conditions, it stays where it is while allowing for a wide range of motions.

There are pros and cons of each procedure, which should be discussed thoroughly with a physician

The joint, however, is not a system in which bone moves against bone. This occurs when debilitating conditions, like arthritis, become advanced. Normally, a shoulder joint includes healthy cartilage that allows for smooth motions.

Conditions Change

Arthritis is a condition marked by painful movement owing to the deterioration of cartilage. This can occur with age, but it can also be accelerated by prolonged athletic activity. As such, some of the more dedicated athletes – because they practice or play a lot – develop arthritis prematurely.

Doctors, however, have traditionally been reluctant to recommend shoulder replacement surgery for someone who is still young. The reasons for this included the expectation that wear and tear of the replacement material, a metal ball and a plastic cup that allows for smooth motion — would eventually wear out, requiring a second operation.

Doctors at the Mayo Clinic now say that carefully selected younger patients could benefit from shoulder replacement surgery. Here are the criteria that doctors should look for when selecting a younger patient for this type of operation:

  • healthy rotator cuff that can hold the new joint in place
  • Healthy socket bone stock (called the glenoid bone)
  • Intact deltoid muscle
  • Persistent pain that does not respond well to conventional treatment
  • A patient motivated to complete physical therapy for post-operative healing and restoration

Discussions

Patients should be aware of the options for a shoulder arthroplasty before selecting the right procedure for them. There are pros and cons of each procedure, which should be discussed thoroughly with a physician.

The options for surgery include a traditional shoulder arthroplasty, a partial shoulder replacement in which just the ball is replaced and a reverse shoulder arthroplasty.

Reverse Arthroplasty

Doctors came to the realization that the ball, which is normally the terminal part of your arm, and the socket, which is on the proximal side, could be reversed. In fact, it is beneficial to reverse the ball and the socket in conditions in which there is a complete rotator cuff tear, which no longer functions well to hold the joint in place.

The gains of a reverse shoulder arthroplasty is better stability when there is little or no functioning soft tissue that can hold the joint together.

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Considering Joint Replacement Surgery? As Your Local AI

By  aenriquez  published  May 31, 2019

Let’s preface this news with the clear understanding that patients undergoing total knee or total hip replacement surgery should consult with their physicians and ask every question they can think to ask. Then ask a few more questions. Then ask a few more.

However, to whom shall your physician go to ask questions? It turns out, the answer to that may well be to a machine. The reason: A new study conducted at the Hospital for Special Surgery in New York City found that computers plowing through various algorithms could reasonably predict which patients undergoing these two critical operations would benefit from the surgery and which ones would not.

Predicting the outcome is not always easy for man or machine, but there may be better outcomes if the two work together

“Machine learning has the potential to improve clinical decision making and patent care by helping prioritize resources for post-surgical monitoring and informing pre-surgical discussions of likely outcomes,” the study found. In so many words, that means, patients should ask their doctors every question they can think up. Doctors, on the other hand, would do well to consult the Oracle, which is to say, they should turn to their computers to help guide their decisions.

Predicting the outcome is not always easy for man or machine, but there may be better outcomes if the two work together. This should never mean allow the computer to take a decision out of your hands. But algorithms in the study did have reasonable predictions concerning whether or not patients, two years after surgery, were benefiting from the knee or hip replacements.

The study was lengthy and included thousands of patients. The data collected involved 7,239 hip replacement surgeries and 6,480 knee replacement surgeries done between 2007 and 2012. According to a press release, “using data about both physical and mental status of patients before and two years after procedures, the investigators were able to calculate whether a patient achieved an MCID across four patient-reported outcome measure scores.” Those scores included self-reporting assessments of general physical health, general mental health, plus measures for hip health and knee health.

An MCID, meanwhile, is a clinical term for “did it work?” Technically, MCID stands for minimal clinically important differences. So, maybe the better translations would be: “did you even notice that the surgery worked?”

Of course, this may be the type of study that will not cause much excitement in the general public, which includes those too cynical to believe these predictions are possible and those who assumed computers were helping orthopedic surgeons make critical decisions all along. But, the point for physicians is a bit more important, because doctors live so close to the action that any miscalculation in this regard is considered a very bad day at work.

Nobody likes unnecessary surgery, but especially so if predictions of outcomes are made easier or more accurate. “The least valuable health care is that which is not wanted or needed,” said one of the senior authors of the study Catherine MacLean, MD, Ph.D., HSS, Chief Value Medical Officer at the hospital.

“Accurate prediction of whether individual patients will achieve a meaningful improvement after the procedure will greatly assist patients and their physicians in determining the best course of therapy,” MacLean said.

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Regenerative Medicine can relieve your Joint Pain

By  david@ogrelogic.com  published  May 22, 2019

Are you considering surgery for your chronic knee or other joint pain? Have you tried conservative treatments but not obtained enough relief? Maybe you should consider Regenerative Medicine. Innovative and advanced regenerative medicine treatments, such as PRP therapy, can enhance the body’s natural healing ability, providing remarkable solutions for all types of joint pain.

The body uses natural growth factors and stem cells to repair and regenerate tissues. These can be obtained from your own body in the form of PRP (Platelet Rich Plasma) or stem cells. Platelet-rich plasma is derived from blood taken from the person’s own body. Platelet rich plasma contains platelets and growth factors essential for healing.

How does PRP treatment help with joint pain?

Chronic joint pain is often the result of loss or wear and tear of the smooth, articular cartilage that helps the bones of a joint glide over each other during movement. Joint pain is mainly caused by osteoarthritis or inflammation of the joint due to rubbing of the bones against each other. Pain may result from injury to the soft tissues surrounding the joint such as ligaments, tendon, and bursae.

When fluoroscopy-guided injections of PRP are administered into a joint over a period of time, the cartilage regenerates, pain reduces and joint function improves.

Regenerative medicine treatments allow deep tissue healing and can be used to effectively treat joint pain and delay the need for surgery. Discuss with your orthopedic if regenerative medicine options are right for you.

 

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Pathologic Fractures

By  aenriquez  published  May 2, 2019

A pathologic fracture may be defined as a break in a bone caused by an underlying disease. An otherwise healthy bone typically fractures as a result of trauma. A diseased bone may do so either without trauma or due to minimal trauma. Diseases of the bone that predispose bones to fracture easily include osteoporosis, osteomyelitis, osteomalacia, Paget’s disease and malignancy (primary or secondary).

 

Pathologic fractures can affect any bone that is diseased, and the symptoms depend on the type and location of the bone involved. Many diseases affect the spinal vertebrae, which are prone to pathologic fractures, which can cause a range of symptoms from pain in back, legs, and arms to neurological impairment, such as numbness and/or weakness in the arms or legs.

Pathologic fractures can affect any bone that is diseased, and the symptoms depend on the type and location of the bone involved

Pathologic fractures are detected on imaging, which is initiated either by a suggestive history and physical exam or staging, restaging or surveillance workup for cancers.

 

  • X-ray – plain film radiographs provide an overall assessment of bone integrity and the presence and the extent of the fracture. It can also detect spinal dislocation or slippage, kyphosis, scoliosis, etc. In addition to these, it can detect specific bony abnormalities such as bone spurs, disc space narrowing, vertebral body fracture, collapse or erosion, etc. Dynamic or flexion/extension X-rays may help in detecting any abnormal or excessive movement or instability in the spine at the affected levels.
  • Computed tomography scan (CT scan) – shows more detailed images of the bones and the soft tissue, and is best suited for evaluating the extent of the fracture.
  • Magnetic resonance imaging (MRI) – is more suitable for evaluating soft tissue damage occurring as a result of the fracture. It is especially useful for the detection of neural damage. MR (or CT) angiography is considered when vascular compromise is suspected.
  • Nuclear bone scan – this scan can be helpful when surveilling for distant bone metastases, in addition to detecting bone infections, especially when MRI is not possible.

 

The goals of treatment are pain relief, reversal or stabilization of neurological deficits and stabilization. For less severe pathologic fractures, nonoperative/conservative management is considered. Severe pathologic fractures require surgical treatment, and the choice of procedure is based on the location of the bone and the extent of the injury. Spinal pathologic fractures can lead to collapsed vertebrae and vertebroplasty or kyphoplasty is required, during which a cement mixture is injected into the fractured bone to stabilize the fracture, treat pain, and prevent further spinal deformity from progressing. In cases where the collapsed vertebrae impinge on the nerve roots or the spinal cord itself, the surgeon may need to remove diseased bone to relieve pressure and possibly perform a spinal fusion to stabilize the spine until it heals. The underlying disease process needs to be adequately managed as well – whether it’s bisphosphonates for osteoporosis or suitable cancer treatment for metastatic disease.

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Sacral Fractures

By  aenriquez  published  April 25, 2019

The sacrum is formed by the fusion of 5 sacral vertebrae and articulates with 5th lumbar vertebra proximally and coccyx distally, and with ilia at sacroiliac joints bilaterally. It contains 4 foramina which transmit sacral nerves (L5-S5), which are responsible for the functions of anal sphincter tone / voluntary contracture, bulbocavernosus reflex and perianal sensation. As an osseous structure, sacrum transmits the load distributed by the first sacral segment through iliac wings to the acetabulum.

Sacral fractures are quite common, occurring in up to 45% of pelvic ring injuries related to high energy trauma (in young adults) or low energy falls (in elderly). They are often underdiagnosed and as a consequence, they are frequently mistreated and lead to serious complications such as neural damage (25% of all cases).

Transverse sacral fractures also have a high incidence of nerve dysfunction

The presence of a neurologic deficit is the most single most important factor in predicting the outcome. Untreated fractures with neurologic deficits lead to symptoms of lower extremity motor/sensory deficits and/or urinary/rectal/sexual dysfunction.

Sacral fractures are classified according to the Denis classification. Zone 1 fractures (50% of all) are lateral to the foramina and are least related to a nerve injury. Zone 2 fractures are through foramina, and based on whether they are stable or unstable, have an increased risk of nonunion, nerve damage and poor functional outcome. Fractures that are medial to foramina are associated with the highest rate of neurological deficit (60%), such as bowel, bladder, and sexual dysfunction. Transverse sacral fractures also have a high incidence of nerve dysfunction.  The u-type sacral fractures result from axial loading and represent spino-pelvic dissociation; these too have a high incidence of neurologic complications.

The clinical diagnosis begins with taking a proper history – motor vehicle accident or fall from height are the most common causes of these fractures, but repetitive stress, insufficiency fracture in osteoporotic adults are also important predisposing factors. The most prominent symptom is peripelvic pain. The physical exam should include testing for pelvic ring stability by internally and externally rotating iliac wings, palpating for subcutaneous fluid mass indicative of lumbosacral fascial degloving, as well as performing a vaginal exam in women to rule-out open injury. A focused neurologic, vascular and rectal exams are also important to assess the degree of tissue damage.

Radiographs are required to diagnose a sacral fracture, although only 30% show sacral fractures. CT is by far the diagnostic study of choice for proper assessment of the fracture, while MRI is considered when neural compromise is suspected.

Nonoperative management includes progressive weight bearing with orthosis if needed, and can only be considered in patients with <1 cm displacement and no neurologic deficit, and in cases of insufficiency fractures. Surgical fixation (without decompression) should be considered if there is a displaced fracture >1 cm with associated soft tissue compromise and persistent pain after non-operative management, and also if there is displacement of fracture after non-operative management. Surgical fixation with decompression is the treatment of choice whenever there is evidence for neurologic injury.

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