Classification of lumbopelvic fractures should inform how surgeons treat these injuries
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Due to the heterogeneous nature of lumbopelvic fractures, particularly those involving the sacrum, these fractures should be classified prior to commencing treatment, a presenter said.
“Based on how you classify these injuries, that gives you an idea of how best to treat them,” Carlo Bellabarba, MD, said during a symposium at the Lumbar Spine Research Society Annual Meeting. “You basically use the same principles [you] would do with other types of unstable spine or pelvic fractures: realign the spine, decompress the neural elements and then, stabilize.”
The AO classification system is typically used to classify lumbopelvic and lumbosacral fractures. However, according to Bellabarba, among the classification systems applicable to lumbopelvic fractures, “none of these systems address neuro status, which is one of the primary determinants in how we treat patients.”
Bellabarba, an orthopedic trauma surgeon at University of Washington and an Orthopedics Today Editorial Board Member, reviewed principles of reduction, decompression and stabilization during his presentation.
Regarding proper reduction of these fractures, he said, “That’s probably the most common question I get now is, ‘How do you reduce these?’ They’re not easy to reduce. Unfortunately, there is not one cookbook way to get a reduction of these injuries.”
However, Bellabarba said getting the reduction done right goes a long way to achieving successful decompression of the fracture.
This is particularly the case with C3-type insufficiency spinopelvic fractures or injuries, he said. “A decompression is partly addressed by simply getting a reduction” because it reduces the kyphosis in the translation, Bellabarba said.
Concerning fracture stabilization, surgeons should determine if the instability that a patient has is spinopelvic or is limited to the pelvis. Such information drives the treatment strategy, according to Bellabarba.
It is also important to assess and understand of the full extent of these injuries, he said. “Typically, these high-energy injuries require a significant amount of stabilization. They are not the type of injury you want to skimp on with regard to hardware.”
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