• So Kato and Stephen J Lewis.
• *Division of Orthopaedic Surgery, the Hospital for Sick Children, Toronto, Ontario, Canada †Division of Orthopaedics, Toronto Western Hospital, Toronto, Canada.
• Spine. 2016 Jul 7.

Study DesignCase report.ObjectiveTo 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 DataPedicle fracture is a possible complication in pedicle screw fixation for scoliosis, which may lead to post-operative 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.MethodsA retrospective chart and radiograph review of a 13-year-old female that underwent surgical treatment for correction of AIS was performed.ResultsFollowing 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.ConclusionsTemporary 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 Evidence4.

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