Journal of orthopaedic trauma · 2026
Asymmetric Sacral Dysmorphism: Prevalence and Impact on Surgical Planning.
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Amin Adeet, Barth Kathryn, Ward Colin, DeAngelis Ryan, Schimizzi Gregory, Park Connor, Routt Milton L, Warner Stephen J, Kellam Patrick, Adams Mark R, Eastman Jonathan G
Аннотация
OBJECTIVES: To determine the prevalence and surgical relevance of asymmetry in patients with sacral dysmorphism.
DESIGN: Retrospective review.
SETTING: Level 1 academic trauma center.
PATIENT SELECTION CRITERIA: Included were patients between 16 and 85 years old with an operative pelvic ring injury (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen (OTA/AO) 61A-C) and a thin-cut pelvis computed tomography (≤2.0 mm) with 3D reformats. Sacral dysmorphism was defined by the inability to place a transiliac-transsacral screw in the upper sacral segment.
OUTCOME MEASURES AND COMPARISONS: Asymmetry was assessed by evaluating side-to-side differences in neuroforaminal height, upper sacral segment pathway obliquity, and anterior-posterior pathway width.
RESULTS: The group of patients with asymmetric sacral dysmorphism was 52.9% female while the group with symmetric sacral dysmorphism and without sacral dysmorphism was 36.3% female and 44.3% female, respectively. The average age of the patients with asymmetric, symmetric, and no sacral dysmorphism was 43.0 years (range 16-89), 42.9 years (range 18-94), and 47.5 years (range 33-89), respectively. Of the 220 patients evaluated, there were 114 (51.8%) patients who demonstrated sacral dysmorphism. Among dysmorphic patients, 34 (29.8%) exhibited at least 1 feature of asymmetry. Asymmetric features included differences in neuroforaminal height, upper sacral segment pathway obliquity, and pathway width.
CONCLUSIONS: Approximately 30% of patients with sacral dysmorphism demonstrated asymmetric features, which can affect surgical planning. Recognition of asymmetric sacral dysmorphism is important for proper execution of posterior pelvic fixation.
LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Retrospective review.
SETTING: Level 1 academic trauma center.
PATIENT SELECTION CRITERIA: Included were patients between 16 and 85 years old with an operative pelvic ring injury (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen (OTA/AO) 61A-C) and a thin-cut pelvis computed tomography (≤2.0 mm) with 3D reformats. Sacral dysmorphism was defined by the inability to place a transiliac-transsacral screw in the upper sacral segment.
OUTCOME MEASURES AND COMPARISONS: Asymmetry was assessed by evaluating side-to-side differences in neuroforaminal height, upper sacral segment pathway obliquity, and anterior-posterior pathway width.
RESULTS: The group of patients with asymmetric sacral dysmorphism was 52.9% female while the group with symmetric sacral dysmorphism and without sacral dysmorphism was 36.3% female and 44.3% female, respectively. The average age of the patients with asymmetric, symmetric, and no sacral dysmorphism was 43.0 years (range 16-89), 42.9 years (range 18-94), and 47.5 years (range 33-89), respectively. Of the 220 patients evaluated, there were 114 (51.8%) patients who demonstrated sacral dysmorphism. Among dysmorphic patients, 34 (29.8%) exhibited at least 1 feature of asymmetry. Asymmetric features included differences in neuroforaminal height, upper sacral segment pathway obliquity, and pathway width.
CONCLUSIONS: Approximately 30% of patients with sacral dysmorphism demonstrated asymmetric features, which can affect surgical planning. Recognition of asymmetric sacral dysmorphism is important for proper execution of posterior pelvic fixation.
LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.