Malgaigne Fracture in Childhood
A Case Report and Review of Literature
Mustafa Kaya, MD, Can Yaldiz, MD, Davut Ceylan, MD
Medicine – Volume 95, Number 4, January 2016 ISSN: 0025-7974
JACO Editorial Reviewer: Jaroslaw P. Grod, D.C., FCCS(C)
Published: September 2017
Journal of the Academy of Chiropractic Orthopedists
September 2017, Volume 14, Issue 3
The original article copyright belongs to the original publisher. This review is available from: http://www.dcorthoacademy.com ©2017 Grod and the Academy of Chiropractic Orthopedists. This is an Open Access article which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sacrum fractures are rare pathologies seen after spinal trauma. The incidence of a sacral fracture after trauma is 0.6% in childhood. A Malgaigne fracture is composed of fractures and dislocations of the anterior and posterior regions of the pelvis. This is the first reported case of Malgaigne fracture during childhood
A 12-year-old girl was admitted to our emergency room after having suffered a fall. Radiological tests revealed a zone 3 sacral fracture according to Denis scoring, a subtype 2 sacral fracture according to Roy-Camille classification, and a detachment in the symphysis pubis. Appropriate load distribution through a bilateral L6 – S1 – S2 transpedicular screw and a bilateral iliac with wing screw, as well as neural decompression were performed together with an S1 – S2 total laminectomy.
It is very difficult to make a generalization for treatment of sacral fractures and Malgaigne fractures in childhood due to the small number of patients. Each patient should be individualized and lumbosacroiliac instability should be treated
Medicine 95(4): e2521
JACO Editorial Summary:
- This article was written by authors from the following institutions:
- Department of Neurosurgery, Karadeniz Eregli State Hospital, Zonguldak, Turkey (MK); Department of Neurosurgery, Sakarya Training and Research Hospital, Sakarya, Turkey (CY, DC)
- A Malgaigne fracture is composed of fractures and dislocations of the anterior and posterior regions of the pelvis.
- This appears to be the first reported case of Malgaigne fracture during childhood where a 12-year-old girl was admitted to the emergency room after having suffered a fall
- Sacral fractures are rare injuries in children with an incidence of 0.6%.
- Even rarer is a transverse sacral fracture associated with an unstable pelvic ring.
- This 12-year-old girl fell from a height of approximately 12 m on her left leg then hit her hip on the ground vertically.
- She had severe thigh and left leg pain
- No neurological deficits or incontinence were noted
- Abdominal examination was normal
- Lumbar CT revealed a zone 3 sacral fracture according to the Denis classification, a sub type 2 fracture according toto the Roy-Camille classification, an S1 – S2 listhesis and a right sacroiliac dysfunction.
- The patient was placed prone on the operating table and was under general anesthesia. The paravertebral muscles between L4 and S3 were stripped subperiosteally.
- S1 and S2 total laminectomy was performed and nerve decompression was provided
- Transpedicular screws were placed at the L5, S1 and S2 vertebrae bilaterally
- Pedicle screws were connected with a rod system.
- Bilateral iliac wing screws were placed and both iliac wings were attached to the system through a connector.
- No post-operative problems were seen.
Summary and Main Message
In Malgaigne fractures, the sacrospinous and sacrotuberous ligaments are also torn in addition to the posterior sacroiliac complex.
Comparative studies have shown that all current sacroiliac fixation methods have close stability with regard to biomechanical properties. Another result of these studies is that no methods can reach the stability of the intact pelvis.
Due to limited number of cases it is difficult to make treatment generalizations.
Although a Malgaigne fracture is not a common condition seen in a chiropractic practice, it is essentially useful to understand the mechanism of injury and the structures involved.