title: Iatrogenic Lumbar Vertebral Fracture during Osteosynthesis for a Trochanteric Fracture of the Femur in Diffuse Idiopathic Skeletal Hyperostosis.
abstract: Vertebral fractures occur with only slight trauma in patients with diffuse idiopathic skeletal hyperostosis (DISH). However, a lumbar vertebra fracture, due to an intraoperative body position has not been previously reported. An 87-year-old woman with kyphosis sustained a left trochanteric fracture of her femur. The patient was placed in a supine position during the operation. Postoperatively, the patient experienced severe right thigh pain. Magnetic resonance imaging revealed an L4 vertebral fracture. Computed tomography revealed ankylosis from the upper thoracic spine to the sacrum. While in a supine position under general anesthesia, the contact of the patient's lower back with operating table likely created a fulcrum at her lumbosacral spine acting as a long lever arm, bearing the mass of her upper body. We performed L1-S2 posterior stabilization. DISH patients with kyphosis placed in a supine position have an increased risk for lumbar vertebral fracture.
authors.affiliation: Department of Orthopedics Surgery, Toyama Prefectural Central Hospital, Kanazawa University, Kanazawa, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sasagawa
authors.affiliation: Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Murakami
authors.affiliation: Department of Orthopedics Surgery, Toyama Prefectural Central Hospital, Kanazawa University, Kanazawa, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Maruhashi
authors.affiliation: Department of Orthopedics Surgery, Toyama Prefectural Central Hospital, Kanazawa University, Kanazawa, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Segawa
authors.affiliation: Department of Orthopedics Surgery, Toyama Prefectural Central Hospital, Kanazawa University, Kanazawa, Japan.
authors.forename: Daiki
authors.initials: D
authors.lastname: Yamamoto
authors.affiliation: Department of Orthopedics Surgery, Toyama Prefectural Central Hospital, Kanazawa University, Kanazawa, Japan.
authors.forename: Shusuke
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Department of Orthopedics Surgery, Toyama Prefectural Central Hospital, Kanazawa University, Kanazawa, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Morita
authors.affiliation: Department of Orthopedics Surgery, Toyama Prefectural Central Hospital, Kanazawa University, Kanazawa, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Nakamura
keywords: Diffuse idiopathic skeletal hyperostosis; Iatrogenic fracture; Kyphosis; Lumbar vertebral fracture; Supine position