Traumatic spondylopelvic dissociation is an extremely rare injury resulting in mechanical dissociation of the pelvis from the spine1. Similar mechanical dysfunction can occur in association with lumbosacral fracture-dislocation or bilateral sacroiliac joint dislocation2-9. However, traumatic spondylopelvic dissociation is a distinct injury pattern, characterized by a transverse sacral fracture in conjunction with bilateral sacroiliac fracture-dislocation, that requires a unique approach to overall patient management and surgical stabilization1,10-12. Options for the surgical treatment of spondylopelvic dissociation are limited as the sacrum may not provide structural support or stability for internal fixation. Our patients were informed that data concerning the cases would be submitted for publication.
Case 1. A nineteen-year-old woman who was wearing a helmet while riding as a passenger on a motorcycle was ejected at high speed, struck a tree, and subsequently was run over by an eighteen-wheel tractor-trailer. She initially presented to an outside hospital with a Glasgow Coma Score of 15 but was unable to move either lower extremity. She was intubated because of respiratory distress, and a chest tube was inserted bilaterally for the treatment of pneumothorax. A diagnostic peritoneal lavage was positive, and the patient underwent exploratory laparotomy. She had multiple musculoskeletal injuries, including spondylopelvic dissociation with highly comminuted sacral fractures that had both vertical and transverse components (Fig. 1-A), a closed fracture of the proximal part of the right femoral shaft, a comminuted fracture of the left acetabulum, open midshaft fractures of the left tibia and fibula, left metacarpal fractures, and degloving injuries of both feet. The open fractures of the left tibia and fibula were irrigated and débrided in the operating room and then were stabilized with external fixation. A traction pin was placed in the distal part of each femur. The …
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