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Complete lumbosacral dislocation
Complete
Lumbosacral REPORT
RICHARD K. WHITE,
OF A CASE M.D.,
Allentown, Pennsylvania
OMPLETE IumbosacraI
dislocation is rare. investigation of the literature for the past several years revealed no similar instance. The severity of the disIocation together with multiple associated injuries presented an interesting problem in care and management.
C An
compound fracture dislocation of the right ankle and a compound fracture of the left tibia. FolIowing admission to the hospital she was treated initialIy for shock, pain and hemorrhage. The patient had no movement of her legs and no sensation below her knees. Reduction of the dislocation was accomplished in bed under spinal ancsthesia. During the performance of a spinal tap, what appeared to be pure bIood ran out through the needfe but, after a short time elapsed, the Ilo~ became less thick and it was assumed that the needle placement was in the dural canal. Manipulative reduction was carried out by traction in the supine position. Both hips and knees were Ilcxcd across the operator’s shoulders while the compounded extremities were supported by attendants and traction was esccuted downward and forward.
CASE REPORT A forty-three year old Negro woman was admitted to the hospita1 foIlowing an automobile accident in December 1956. In addition to the complete lumbosacral dislocation as shown in Figure I, she sustained multiple Iacerations of the left arm and both legs. There were fractures of the third to the tenth ribs, incIusive, on the left side, a fracture of the distal end of the left clavicle, a
Fro. I. Koentgenograrn
showing lumbosacral
Dislocation
Fro. 2. Roentgenogram
disIocation.
103
American
Journal
after reduction.
OJ Surgery,
Volume
*OS. July
1961
White The result of roentgenographic examination following the reduction is shown in Figure 2. AdmittedIy, the reduction does not appear to be compIete but no further attempts were made to improve the status. The neuroIogic deficit of the patient foIIowing recovery from anesthesia was paraIysis of the motor and sensory nerves below the level of the knee joint. Bladder and bowe1 incontinence were aIso present. The patient was cared for on a Stryker frame with pelvic traction. She became somewhat recalcitrant in the traction and this was removed after ten days. Because of her many d&uIties, the fractures of the Iower extremities were treated by the cIosed pIaster technic, without debridement or any other care except gross positioning. ApproximateIy six months after injury she regained contro1 of her bladder and bowe1 and had no further dificulty with these functions. Two years following injury there was compIete union of both fractures and a11 wounds were healed. ControI of the bIadder and bowe1 had been maintained and a compIete neuroIogic deficit beIow her knees had persisted. She had begun to ambuIate with the use of braces.
COMMENT
This rather unusua1 interesting case aIlowed us to question again the concept of IumbosacraI instability. No externa1 apparatus was used in this instance; in fact, the traction itseIf was discarded shortly after reduction. The need for Iumbosacral fusion was not demonstrated by the patient’s subsequent course, either in changes in her x-ray picture or in symptoms in her back. SUMMARY
A case of complete IumbosacraI dislocation is presented. This case was associated with multiple injuries complicating the problem. It demonstrates a continued stable entity without the need of additional fusion. In addition, the associated injuries were treated on a nondefinitive basis which was accompanied by a good result. WhiIe these methods are not intended to be recommended, they do demonstrate what can be done under unusual circumstances.
104
Lumbosacral REPORT
RICHARD K. WHITE,
OF A CASE M.D.,
Allentown, Pennsylvania
OMPLETE IumbosacraI
dislocation is rare. investigation of the literature for the past several years revealed no similar instance. The severity of the disIocation together with multiple associated injuries presented an interesting problem in care and management.
C An
compound fracture dislocation of the right ankle and a compound fracture of the left tibia. FolIowing admission to the hospital she was treated initialIy for shock, pain and hemorrhage. The patient had no movement of her legs and no sensation below her knees. Reduction of the dislocation was accomplished in bed under spinal ancsthesia. During the performance of a spinal tap, what appeared to be pure bIood ran out through the needfe but, after a short time elapsed, the Ilo~ became less thick and it was assumed that the needle placement was in the dural canal. Manipulative reduction was carried out by traction in the supine position. Both hips and knees were Ilcxcd across the operator’s shoulders while the compounded extremities were supported by attendants and traction was esccuted downward and forward.
CASE REPORT A forty-three year old Negro woman was admitted to the hospita1 foIlowing an automobile accident in December 1956. In addition to the complete lumbosacral dislocation as shown in Figure I, she sustained multiple Iacerations of the left arm and both legs. There were fractures of the third to the tenth ribs, incIusive, on the left side, a fracture of the distal end of the left clavicle, a
Fro. I. Koentgenograrn
showing lumbosacral
Dislocation
Fro. 2. Roentgenogram
disIocation.
103
American
Journal
after reduction.
OJ Surgery,
Volume
*OS. July
1961
White The result of roentgenographic examination following the reduction is shown in Figure 2. AdmittedIy, the reduction does not appear to be compIete but no further attempts were made to improve the status. The neuroIogic deficit of the patient foIIowing recovery from anesthesia was paraIysis of the motor and sensory nerves below the level of the knee joint. Bladder and bowe1 incontinence were aIso present. The patient was cared for on a Stryker frame with pelvic traction. She became somewhat recalcitrant in the traction and this was removed after ten days. Because of her many d&uIties, the fractures of the Iower extremities were treated by the cIosed pIaster technic, without debridement or any other care except gross positioning. ApproximateIy six months after injury she regained contro1 of her bladder and bowe1 and had no further dificulty with these functions. Two years following injury there was compIete union of both fractures and a11 wounds were healed. ControI of the bIadder and bowe1 had been maintained and a compIete neuroIogic deficit beIow her knees had persisted. She had begun to ambuIate with the use of braces.
COMMENT
This rather unusua1 interesting case aIlowed us to question again the concept of IumbosacraI instability. No externa1 apparatus was used in this instance; in fact, the traction itseIf was discarded shortly after reduction. The need for Iumbosacral fusion was not demonstrated by the patient’s subsequent course, either in changes in her x-ray picture or in symptoms in her back. SUMMARY
A case of complete IumbosacraI dislocation is presented. This case was associated with multiple injuries complicating the problem. It demonstrates a continued stable entity without the need of additional fusion. In addition, the associated injuries were treated on a nondefinitive basis which was accompanied by a good result. WhiIe these methods are not intended to be recommended, they do demonstrate what can be done under unusual circumstances.
104