A PARTICULAR LOMBO-SACRAL DISLOCATION IN A SUICIDAL JUMPER - A CASE-REPORT

Purpose of the study We report a particular case of lombo-pelvic dislo cation in a suicidal jumper, characterized by a distal sacral fracture associated with bilateral fractures of both iliac wings. To our knowl edge, it has yet not been described. Material and methods The patient was a 27 years old individual. On admission, he sustained the followin g injuries: hemodynamic shock with intraperitoneal bleeding due to dis ruption of the triangular ligament of the liver, which resolved with b lood transfusions and did not require surgical treatment pelvic fractu res initially identified as transverse fractures of both iliac wings, with bilateral avulsions of sciatic spines a compression fracture of t he first lumbar vertebra without neurologic complication. In the inten sive care unit, evolution was favorable. However, an incomplete cauda equina syndrome was noticed : the anal sphincter was flacid but perian al sensation to pinprick was conserved. An electromyogram showed that the latence of perineal reflexes was increased. The fracture and its d isplacement were recognized secondarily. A pelvic C.T. exhibited an in crease in the antero-posterior dimension of the pelvic ring, due to a distal displaced transverse sacral fracture. The proximal fragment of the sacrum remained attached to the iliac wing since sacro-iliac joint s were intact. Iliac wings had tilted forward, and the distal tip of t he proximal sacral fragment was driven backward and inferiorly. Result s The patient was maintened in the supine position during 3 months. He then rapidly recovered normal function of his lower limbs. He had nor mal gait patterns and pelvic static. He did not complain of any pain. Finally, the neurological deficit disappeared and he regained full sex ual function and complete control of micturition. Discussion We think that this fracture should be considered as a variety of suicidal jumpe r's fracture described by Roy Camille et al. It has the same displacem ent as type 2 fracture in Roy Camille classification. In the emergency room, diagnosis is difficult, based on usual AP pelvic roentgenograms . A bilateral fracture of iliac wings in a suicidal jumper, especially if associated with bilateral sciatic spine avulsions, is an indicatio n to a pelvic C.T. A neurological perineal deficit should be ruled out . In our case, the perineal deficit can be attributed to the stretchin g of sacral roots resulting from a posterior displacement of the sacru m. The favorable evolution suggests that surgery may be not required, and there is no evidence in the literature that it would help neurolog ical recovery. In distal fractures, the sacral canal is not narrowed, and a sacral laminectomy appears therefore not indicated. Conclusion W e have described a particular type of transverse fracture of the pelvi s, which, in our mind, should be put in the same category as type 2 tr ansverse fractures of the sacrum described by Roy Camille and al, in t he suicidal jumper. Since there is no compression of sacral roots into the sacral canal, prolonged bedrest is likely to be the better treatm ent.