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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2008 June;59(3):193-7
Nonunion of the sacrum in unstable pelvic fracture
Rollero L., Gallo A., Bruno L., Matteotti R., Zoccola K., Massè A.
Divisione di Chirurgia del Bacino, Azienda Ospedaliera CTO - CRF Maria Adelaide, Università degli studi di Torino, Torino, Italia
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Unstable pelvic fractures may be complicated by nonunion. Cases of nonunion of the medial region of the sacrum are very few, and just one case of nonunion resulting from this type of lesion is documented. The aim of this study is to review the literature concerning diagnosis and treatment of sacrum nonunions starting from the analysis of a rare case represented by a patient, male, 54 years old, involved in a motorcycle accident suffering from a fracture of the sacrum type “Denis III” developing a later nonunion on this lesion. Nonunion definition as a lack of consolidation of a fracture after 6 months from trauma is not universally accepted in literature, some authors define it as the cessation of both the periosteal and endosteal healing responses without temporal parameters. In our case the rarity of sagittal medial fractures of the sacrum implied a difficult interpretation of the clinical situation. It is important to perform pelvic X-ray examinations if the trauma intensity is compatible with a pelvic fracture, furthermore a CT should also be performed for a better sensitivity and specificity in the diagnosis of pelvic fractures. Early diagnosis and early treatment are very important. A complete diagnostic-therapeutic procedure, a careful X-ray evaluation, and a proper classification of the pelvis fracture type have a key role in treating patients involved in high energy trauma for a correct surgery. In doubtful cases is important to deepen diagnosis with further X-ray examinations and/or CT.