~ 611 ~ International Journal of Orthopaedics Sciences 2019; 5(3): 611-613 ISSN: 2395-1958 IJOS 2019; 5(3): 611-613 © 2019 IJOS www.orthopaper.com Received: 04-05-2019 Accepted: 06-06-2019 Dr. Saurabh Kumar U.C.M.S & G.T.B Hospital, Delhi, India Dr. Deepankar Verma U.C.M.S & G.T.B Hospital, Delhi, India Dr. Ish Kumar Dhammi U.C.M.S & G.T.B Hospital, Delhi, India Dr. Rajnand Kumar U.C.M.S & G.T.B Hospital, Delhi, India Dr. Samarth Mittal A.I.I.M.S, Rishikesh, Uttarakhand, India Correspondence Dr. Deepankar Verma U.C.M.S & G.T.B Hospital, Delhi, India Transverse sacral fracture-dislocation with anterior displacement in 13s year old female: A case report Dr. Saurabh Kumar, Dr. Deepankar Verma, Dr. Ish Kumar Dhammi, Dr. Rajnand Kumar and Dr. Samarth Mittal DOI: https://doi.org/10.22271/ortho.2019.v5.i3k.1597 Abstract Introduction: Sacrum fractures are rare pathologies seen after spinal traumas. The incidence of a sacral fracture after trauma is 0.6% in childhood. Case presentation: A 13-year-old girl was admitted to our emergency room after having suffered a fall. Radiological tests revealed S1 S2 fracture dislocation. Appropriate load distribution through a spino- pelvic fixation as well as neural decompression were performed together with an S1–S2 partial laminectomy. Post operatively iliac screws started impinging so all the screws were removed 3 months post operatively. At one year follow - up patient is walking pain free without any neurological deficit. Conclusion: It is very difficult to make a generalization for treatment of sacral fracture dislocation due to small number of patients. Each patient should be individualized and lumbosacroiliac instability should be treated. Keywords: Transverse sacral fracture-dislocation, anterior displacement, 13 year old female Introduction Sacral fracture dislocation especially transverse fracture with anterior displacement is an uncommon injury. They are classified into longitudinal and transverse fracture. Transverse fracture constitutes 3% to 5% with most of fractures (95% to 97%) being longitudinal fractures Transverse fractures are usually observed following a fall from height, thus it is also named “suicide jumper’s fracture” [1] . Neurological deficit involving sacral roots are common in transverse fractures (96% to 100%). We present such a case in a child who was managed successfully by spino pelvic fixation, attempt of reduction, partial limited laminectomy at S1 S2. Case Report A 13-year-old female who fell down from 10 -12 ft height and presented in our emergency department with pain in abdomen, lower back pain, inability to pass urine. Patient was haemodynamically unstable at presentation with pulse rate 112/min, B.P 80/40 mm Hg, RR 24/min . She was resuscitated with administration of adequate fluids, colloids and blood through two large bore cannulation and oxygen inhalation. USG FAST was done which came to be positive. On further radiological investigations CECT abdomen showed mild haemoperitoneum and mild retroperitoneal hematoma on right side. CT spine showed transverse S1 S2 fracture dislocation.(Fig1) The patient was initially admitted in surgery department and was kept under observation and treated conservatively from their side and subsequently transferred to orthopaedics department after 72 hrs for managing sacral fracture dislocation. The patient was hemodynamically stable when presented in orthopaedics department with pulse rate 80/min and B.P 110/80 mm Hg. she had tenderness on lumbosacral area, with bony protrusion at S1S2. Pelvic compression distraction test was positive, active straight leg raising test was negative. There was no limb length discrepancy. On examination she had superficial abrasions present over lower back and bruises present over bilateral flanks. On neurological examination exact power could not be assessed as she was having severe pain and spasm, no sensory deficit with bladder, bowel involvement. Radiographs of LS spine AP and lateral views, pelvis with both hip joints and pelvis inlet/outlet views were obtained.