Einteilung Sakrumfraktur

Sacral
fractures: How should we classify them?. Typical vertical extension of the fracture line, parallel to the sacroiliac joint (left side). Instead, right sacral wing fracture is comminuted, with multiple fracture lines, but it shows a predominant vertical extension.
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Sacral
fractures: How should we classify them?. Comminuted fracture of the right sacral wing with extension to the sacroiliac joint (blue arrow).
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Sacral
fractures: How should we classify them?. This image shows a fracture line of the transverse process of L5 (blue arrows), suggesting a lesion of the ischiolumbar ligament. Our fracture line is lateral to L5-S1 facet, no lumbosacral instability is expected.
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Sacral
fractures: How should we classify them?. Right sacral zone 2 fracture involving more than one foramen (ventral and dorsal foramina). Neurologic deficits are not common but could be possible.
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Sacral
fractures: How should we classify them?. Absence of the right sacral wing at the level of S4-S5 and anterior sacral foramina involvement (green arrow). Note the presence of a hyperdense soft-tissue haematoma and blurring of right piriformis muscle, probably damaged.
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Sacral
fractures: How should we classify them?. Displaced fracture of the right sacral wing at the level of S4-S5 (green line).
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Sacral
fractures: How should we classify them?. Right lateral sacral crest fracture. Note the extension to the posterior sacral foramina (yellow arrows).
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Sacral
fractures: How should we classify them?. Transverse zone 3 fractures (yellow arrows, a zone 3 fracture subtype II) may be caused by a direct trauma to the sacrum. This kind of fracture involves the central sacral canal and is related to neurological damage.
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Sacral
fractures: How should we classify them?. Bilateral zone 1 fractures (red arrows) affecting both sacral wings.J.A Prat-Matifoll, Radiology Department; Vall Hebron Hospital
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Classification
of sacral fractures • Denis classification of sacral fractures - Ganzer Fall bei Radiopaedia
Skalski M, Denis classification of sacral fractures. Case study, Radiopaedia.org (Accessed on 13 Jan 2024) https://doi.org/10.53347/rID-23215 • CC by-nc-sa 3.0 (modified)
Classification
of sacral fractures • Postpartum sacral stress fracture - Ganzer Fall bei Radiopaedia
Stalkov M, Postpartum sacral stress fracture. Case study, Radiopaedia.org (Accessed on 13 Jan 2024) https://doi.org/10.53347/rID-39449 • CC by-nc-sa 3.0 (modified)
Classification
of sacral fractures • Apical capping due to thoracic fractures, pelvic trauma - Ganzer Fall bei Radiopaedia
Dixon A, Apical capping due to thoracic fractures, pelvic trauma. Case study, Radiopaedia.org (Accessed on 13 Jan 2024) https://doi.org/10.53347/rID-31537 • CC by-nc-sa 3.0 (modified)
Classification
of sacral fractures • Sacral fractures - Denis zone 2 - Ganzer Fall bei Radiopaedia
Knipe H, Sacral fractures - Denis zone 2. Case study, Radiopaedia.org (Accessed on 13 Jan 2024) https://doi.org/10.53347/rID-57769 • CC by-nc-sa 3.0 (modified)
Classification
of sacral fractures • Bilateral acetabular fractures - Ganzer Fall bei Radiopaedia
Hacking C, Bilateral acetabular fractures. Case study, Radiopaedia.org (Accessed on 13 Jan 2024) https://doi.org/10.53347/rID-79272 • CC by-nc-sa 3.0 (modified)
Radiopaedia • CC-by-nc-sa 3.0 • de

There are several classification systems for sacral fractures, but the most commonly employed are the Denis classification and subclassification systems, and the Isler classification system. These classification systems are important to understand as proper classification can impact management.

AO classification of sacral injuries

  • type A: lower sacrococcygeal injuries
  • type B: posterior pelvic injuries
  • type C: spinopelvic injuries

The AO sacral injury classification further subdivides these three injury types and also involves neurological and other modifiers that can be added.

Denis classification

  • zone 1: fracture involves the sacral ala lateral to the neural foramina
  • zone 2: fracture involves the neural foramina, but does not involve the spinal canal
  • zone 3: fracture is medial to the neural foramen, involving the spinal canal; these may be transverse or longitudinal, and can be sub-classified into 4 types:
    • type 1: only kyphotic angulation at the fracture site (no translation)
    • type 2: kyphotic angulation with anterior translation of the distal sacrum
    • type 3: kyphotic angulation with complete offset of the fracture fragments
    • type 4: comminuted S1 segment, usually due to axial compression
Morphologic injury patterns of zone 3 fractures
  • “H” shaped fracture
  • “U” shaped fracture
  • “ʎ” (lambda)  shaped fracture
  • “T” shaped fracture

Isler classification

Used for fractures that involve the lumbosacral articulation:

  • Isler 1: fracture occurs lateral to the L5/S1 facet
  • Isler 2: fractures line involves the L5/S1 facet
  • Isler 3: fracture line extends medially to the L5/S1 facet
Siehe auch:
Assoziationen und Differentialdiagnosen zu Klassifikation Sakrumfrakturen:
Sakrumfraktur
 
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