Complex lumbosacral fracture-dislocation with pelvic ring disruption and vertical shear sacral fracture: a case report of late presentation and review of the literature

Combination of lumbosacral junction injury with closed vertical shear sacral fracture and disruption of the symphysis pubis is a very rare pattern of injury, particularly with a late presentation. To our knowledge, the complexity of such a lumbosacral injury with pelvic fractures, which was presented with a chronic condition, has never been addressed or identified in the previous literature. We aimed to demonstrate a case with a late presentation of a complex lumbosacral fracture-dislocation, pelvic ring disruption and a vertical shear sacral fracture with neurological deficits and to emphasize the difficulties in the management in this case and the operative technique used for the definitive treatment. The initial event had occurred three months earlier. Closed reduction by skeletal traction had failed; therefore, surgical correction was performed by means of indirect reduction via pedicle screws, iliac screws and rods system. Definitive stabilization with posterior lumbo-pelvic segmental fixation and posterolateral fusion were performed using a posterior approach. At one year after surgery, the clinical result was satisfactory with almost complete correction of a deformity and solid posterolateral fusion. The patient had partial recovery from the preoperative neurological deficit. We report herein a patient with a very unusual complex spondylo-pelvic injury pattern with late presentation, which required meticulous planning of management, imaging, and surgical technique before definitive treatment.