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Temporary Iliac Fixation to Salvage an Acute L4 Chance Fracture: Following Pedicle Screw Fixation for Adolescent Idiopathic Scoliosis

Kato, So MD; Lewis, Stephen J. MD, MSc, FRCS(C)

doi: 10.1097/BRS.0000000000001786
Case Report

Study Design. A case report.

Objective. The aim of this study was to describe a technique of temporary distal fixation to the ilium to salvage an acute L4 fracture following a T3-L4 kyphoscoliosis correction.

Summary of Background Data. Pedicle fracture is a possible complication in pedicle screw fixation for scoliosis, which may lead to postoperative instability, resulting in loss of fixation and pseudoarthrosis. This report highlights the salvage treatment of a chance fracture that occurred in the lower instrumented vertebra following deformity correction for adolescent idiopathic scoliosis (AIS) without sacrificing further distal motion segments.

Methods. A retrospective chart and radiograph review of a 13-year-old female who underwent surgical treatment for correction of AIS was performed.

Results. Following a T3-L4 correction with apical posterior column releases, an L4 Chance fracture with loss of distal fixation occurred on post-op day 3. Following an unsuccessful salvage with an infralaminar hook, a second revision was performed replacing the hook and adding bilateral temporary fixation to the ilium connected to the distal ends of the main rods through side-to-side connectors. The temporary fixation was removed 6 months later with successful healing of the fracture maintenance of the scoliosis correction at 2-year follow-up.

Conclusion. Temporary extension of the construct to the ilium was successfully utilized in this case to salvage an acute L4 Chance fracture that occurred following a T3 to L4 construct for kyphoscoliosis. With this technique, successful reduction and healing of the fracture occurred with maintenance of the deformity correction without the need to fuse further distal segments.

Level of Evidence: 4

*Division of Orthopaedic Surgery, the Hospital for Sick Children, Toronto, Ontario, Canada

Division of Orthopaedics, Toronto Western Hospital, Toronto, Canada.

Address correspondence and reprint requests to Stephen J. Lewis, MD, MSc, FRCS(C), Division of Orthopaedics, Toronto Western Hospital, East Wing 1-E442, 399 Bathurst St, Toronto, ON M5T 2S8, Canada. E-mail:

Received 2 December, 2015

Revised 7 June, 2016

Accepted 23 June, 2016

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: payment for development of educational presentations, stocks, travel/accommodations/meeting expenses.

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