title: Retrospective review of lumbosacral dissociations in blast injuries.
abstract: METHODS
  Retrospective review of medical records and radiographs.
  
  
  OBJECTIVE
  We assessed the clinical outcomes of lumbosacral dissociation (LSD) after traumatic, combat-related injuries, and to review our management of these distinct injuries and report our preliminary follow-up.
  
  
  BACKGROUND
  LSD injuries are an anatomic separation of the pelvis from the spinal column, and are the result of high-energy trauma. A relative increase in these injuries has been seen in young healthy combat casualties subjected to high-energy blast trauma.
  
  
  METHODS
  We performed a retrospective review of inpatient/outpatient medical records and radiographs for all patients treated at our institution with combat-related lumbosacral dissociations. Twenty-three patients met inclusion criteria of combat-related lumbosacral dissociations with one-year follow-up. Patients were treated as follows: no fixation (9), sacroiliac screw fixation (8), posterior spinal fusion (5) and sacral plate (1). All patients with radiographic evidence of a zone III sacral fracture, in addition to associated lumbar fractures indicating loss of the iliolumbar ligamentous complex integrity were included.
  
  
  RESULTS
  In 15 patients, the sacral fracture were an H or U type zone III fracture, whereas in the remaining nine, the sacral fracture was severely comminuted and unable to classify (six open fractures). There was no difference in visual analog scale (VAS) between treatment modalities. Two open injuries had residual infections. One patient treated with an L4-ilium posterior spinal fusion with instrumentation required instrumentation removal for infection. At a mean follow-up of 1.71 years (range, 1-4.5), 11 patients (48%) still reported residual pain and the mean VAS at latest follow-up was 1.7 (range, 0-7).
  
  
  CONCLUSIONS
  Operative stabilization promoted healing and earlier mobilization, but carries a high-postoperative risk of infection. Nonoperative management should be considered in patients whose comorbidities prevent safe stabilization.
authors.affiliation: Integrated Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, Washington, District of Columbia 20307, USA.
authors.forename: Melvin D
authors.initials: MD
authors.lastname: Helgeson
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Lehman
authors.forename: Patrick
authors.initials: P
authors.lastname: Cooper
authors.forename: Michael
authors.initials: M
authors.lastname: Frisch
authors.forename: Romney C
authors.initials: RC
authors.lastname: Andersen
authors.forename: Carlo
authors.initials: C
authors.lastname: Bellabarba
mesh_terms: D001753:Blast Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000601:surgery; D008161:Lumbosacral Region; D011859:Radiography; D012189:Retrospective Studies; D012447:Sacrum / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000601:surgery; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D014857:Warfare