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Related Concept Videos

Fractures: Bone Repair01:27

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Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
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Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
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Do all Isler's type sacral fractures necessarily require surgical fixation?

Rishi M Kanna1, K Guna Pratheep2, Ajoy P Shetty2

  • 1Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India. rishiortho@gmail.com.

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
|July 13, 2022
PubMed
Summary

Many Isler

Keywords:
ConservativeIsler’s classificationLumbosacral jointSacral fracturesSurgery

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Area of Science:

  • Orthopedic surgery
  • Traumatology
  • Spinal biomechanics

Background:

  • Unilateral vertical sacral fractures involving the L5-S1 facet joint compromise lumbo-sacral stability.
  • These fractures are traditionally considered indications for surgical fixation.
  • Outcomes of non-operative management for these specific injuries remain under-investigated.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of non-operative treatment for Isler's fractures.
  • To compare functional and radiological results between operative and non-operative management of Isler's fractures.
  • To determine the incidence and characteristics of Isler's fractures within a defined patient cohort.

Main Methods:

  • Retrospective review of sacral fractures over five years to identify Isler's fractures.
  • Collection of demographic, surgical, and imaging data (radiographs, CT scans).
  • Assessment of functional outcomes using Visual Analog Scale (VAS), SF-12, and return-to-work data.

Main Results:

  • Isler's fractures occurred in 18% of cases, with a mean age of 42.1 years.
  • Fractures involved the L5-S1 joint (Type 2a/2b) or facets (Type 1); Type 3 were absent.
  • Non-operative treatment (n=16) and surgical treatment (n=18) showed similar radiographic union, VAS scores, squatting/sitting ability, return to work, and Majeed scores at 15.2 months follow-up.

Conclusions:

  • Approximately 47% of Isler's fractures present with mechanical stability.
  • Non-operative management can yield favorable radiological and functional outcomes for stable Isler's fractures.
  • This study challenges the universal indication for surgery in all Isler's fracture cases.