title: U-shaped sacral fracture and lumbosacral dislocation as a result of a shotgun injury: case report.
abstract: OBJECTIVE
  Gunshot wounds to the spine and/or sacrum rarely cause spinal instability. Our goal is to report the first case of a U-shaped sacral fracture and lumbosacral dislocation caused by a gunshot injury to the spine.
  
  
  METHODS
  A 37-year-old man sustained a close-range shotgun wound to the abdomen. The blast partially destroyed the L4 and L5 vertebral bodies and fractured the S1 and S2 segments of the spine, resulting in severe neurological deficits with lumbosacral and spinopelvic instability.
  
  
  METHODS
  Debridement of devitalized tissues, proper antibiotic coverage, decompression of the cauda equina, and lumbopelvic fixation.
  
  
  CONCLUSIONS
  Close-range shotgun injuries result in massive destruction of tissues. As opposed to civilian injuries, a different approach must be taken to prevent infectious complications. A bilateral lumbopelvic fixation using long iliac screws effectively restored lumbosacral pelvic stability.
authors.affiliation: Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, WA 98104-2499, USA. mdvilela@u.washington.edu
authors.forename: Marcelo D
authors.initials: MD
authors.lastname: Vilela
authors.forename: Mikhail
authors.initials: M
authors.lastname: Gelfenbeyn
authors.forename: Carlo
authors.initials: C
authors.lastname: Bellabarba
mesh_terms: D000328:Adult; D005389:Firearms; D050723:Fractures, Bone / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery; D008161:Lumbosacral Region / Q000293:injuries* / Q000601:surgery; D008297:Male; D019637:Orthopedic Procedures; D012447:Sacrum / Q000293:injuries* / Q000601:surgery; D016103:Spinal Fractures / Q000473:pathology / Q000601:surgery; D014948:Wounds, Gunshot / Q000473:pathology* / Q000601:surgery