Butterfly vertebra presenting with a sacral fracture and pel
Butterfly vertebrae are congenital sagittal defects in the vertebral body caused by failure of fusion of the two chondrification centers during embryonic development.

The present case, published in the journal Trauma Case Reports, describes an incidental finding of a scaral butterfly vertebra in a patient with a Denis zone 1 sacral fracture with superior and inferior rami fractures (AO/OTA 61-C1.3). This is the first described case of a butterfly vertebra presenting as an incidental finding with a sacral fracture and pelvic ring injury.

This is a 34 YOM roofer who fell 20 ft off a roof landing on his back and was subsequently unable to ambulate secondary to pain. He was brought to our facility by ambulance where a level 2 trauma was activated. He had a previous history of multiple trauma following a fall 2 years earlier during which he suffered from a closed pilon fracture.

CT scan of his chest and abdomen revealed healed previous rib fractures from past injury as well as a Kommerell diverticulum with an aberrant left subclavian artery however no other rib abnormalities were noted. AP radiographs and CT scanning of the pelvis showed the presence of a complete left Denis zone 1 sacral fracture with superior and inferior rami fractures (AO/OTA 61-C1.3).

The patient was found to have a congenital sagittal cleft of the S1 vertebral body-or butterfly vertebrae which was an incidental finding. He was also noted to have sacralization of his left L5 vertebrae, with pseudoarticulation of the transverse process with the sacral ala through which he had also fractured. CT examination of the cervical, thoracic and lumbar spine did not reveal any other congenital malformation, however the patient was noted to have a traumatic compression fracture of L2.

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