Asian Spine J.  2015 Oct;9(5):803-806. 10.4184/asj.2015.9.5.803.

Iatrogenic Lumbar Vertebral Fracture during Osteosynthesis for a Trochanteric Fracture of the Femur in Diffuse Idiopathic Skeletal Hyperostosis

• Sasagawa T
• Murakami H
• Maruhashi
• Segawa T
• Yamamoto D
• Shimizu S
• Morita Y
• Nakamura T

• KMID: 2148379
• DOI: http://doi.org/10.4184/asj.2015.9.5.803

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.

Keyword

Diffuse idiopathic skeletal hyperostosis; Iatrogenic fracture; Kyphosis; Lumbar vertebral fracture; Supine position

MeSH Terms

Aged, 80 and over
Anesthesia, General
Ankylosis
Arm
Female
Femur*
Humans
Hyperostosis, Diffuse Idiopathic Skeletal*
Kyphosis
Magnetic Resonance Imaging
Operating Tables
Sacrum
Spine
Supine Position
Thigh