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Updated: Jun 12, 2025

C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position

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Published on: September 16, 2022

L5-S1 facet joint pathology in pelvic ring injuries.

Nicholas C Danford¹, Celeste Tavolaro², Suzanna Ohlsen²

¹Department of Orthopaedic Surgery, Columbia University Irving Medical Center, 630 W 168TH St., PH-11 Center, New York, NY, 10032, USA. ncd2117@cumc.columbia.edu.

European Journal of Orthopaedic Surgery & Traumatology : Orthopedie Traumatologie

|September 23, 2024

Summary

L5-S1 facet joint injuries are common in pelvic ring fractures, particularly in younger patients with high-energy trauma. Radiologists often miss these injuries, necessitating careful review of imaging for sacral fracture patterns.

Keywords:

L5-S1 facet injury Lumbopelvic fixation Missed injury Pelvic ring injury Spinopelvic fixation

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Published on: February 14, 2025

Area of Science:

Orthopedic Surgery
Radiology
Trauma Care

Background:

L5-S1 facet joint injuries are frequently overlooked in pelvic fracture cases.
A significant gap exists in the recognition of these injuries by orthopedic traumatologists.

Purpose of the Study:

To identify demographic and injury characteristics associated with L5-S1 facet joint injuries.
To assess the rate at which L5-S1 facet joint injuries are missed in initial radiographic evaluations.

Main Methods:

Retrospective comparative study of adult patients with acute pelvic ring injuries (AO/OTA 62 B-C).
Analysis of demographic data, injury patterns, and radiographic reports.
Inclusion of 476 patients from a single Level I trauma center.

Main Results:

11.1% of patients (53/476) sustained L5-S1 facet joint injuries.
Younger patients and high-energy mechanisms were associated with these injuries (p<0.002).
Specific sacral fracture patterns (Denis zones 2 & 3, bilateral displaced sacral fractures) and L5 transverse process fractures significantly correlated with L5-S1 injuries (p<0.001).

Conclusions:

L5-S1 facet joint injuries are underappreciated in pelvic ring injuries.
Radiologists identified only 16.0% of these injuries on initial review.
Increased vigilance for L5-S1 facet joint injuries is crucial, especially with specific sacral fracture patterns.