Case Report

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Journal of Acupuncture Research 2023; 40(3): 281-292

Published online August 31, 2023

https://doi.org/10.13045/jar.2023.00171

© Korean Acupuncture & Moxibustion Medicine Society

Integrative Korean Medicine Treatment for Sacral Fracture: Two Clinical Cases

Yeon Soo Kang , Pil Je Park , So Jeong Kim , Hyun Jin Jang , Min Ju Kim , Hyeon Kyu Choi , Jeong Kyo Jeong , Ju Hyun Jeon , Young Il Kim

Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Korea

Correspondence to : Young Il Kim
Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, 75, Daedeok-daero 176beon-gil, Seo-gu, Daejeon 35235, Korea
E-mail: omdkim01@dju.kr

Received: July 22, 2023; Revised: August 12, 2023; Accepted: August 15, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

This study presents the cases of a 67-year-old female with an isolated left sacral fracture and a 69-year-old female with fractures in sacrum 1, 2, and the left pubic bone. Both patients exhibited marked improvement following integrative Korean medicine treatment, encompassing acupuncture, acupotomy, pharmacopuncture, herbal medicine, moxibustion, and cupping therapy. The treatment’s efficacy was assessed using the numerical rating scale (NRS) scores, range of motion (ROM) in the lumbar spine, and alterations in gait and walking distance. Case 1 demonstrated an enhanced ROM and achieved independent walking after 29 days of treatment. Case 2 improved in both ROM and NRS score and could walk independently after 49 days of treatment. Significantly, radiological images showed notable changes in both cases following treatments. The study indicates that integrative Korean medicine treatment could provide clinical advantages to individuals suffering from sacral fractures.

Keywords Acupotomy; Acupuncture; Herbal medicine; Korean traditional medicine; Pharmacopuncture; Spinal fractures

Most sacral fractures are the result of an external force exerted on the pelvis or spine, typically associated with other fractures [1]. They can lead to pelvic ring or spine-pelvis instability, with 25% of such fractures causing nerve injury due to the location of the lumbosacral plexus [2-4]. Radiologically, sacral fractures can be challenging to detect and often present no typical clinical symptoms [4-6]. Concurrent injuries may conceal nerve damage, delaying diagnosis in approximately 30% of sacral fractures if not identified and managed properly [2-8].

Treatment for sacral fractures may be surgical or conservative, depending on the stability of the pelvic fracture and the presence of neurological symptoms [4]. However, a clear consensus on treatment methods and principles is lacking, therefore conservative treatment typically employed if the fracture region does not include unstable pelvic fractures or neurological disorders [1,9].

Studies by Lee et al. [10] and Ha et al. [11] have shown that integrative Korean medicine treatment significantly impacts patients with both sacral and multiple fractures. This makes it challenging to ascertain the specific efficacy of integrative Korean medicine on isolated sacral fractures alone. Moreover, there are no case reports or studies concerning the effect of Korean medicine treatment on isolated sacral fractures or associated radiological changes.

In the present study, integrative Korean medicine treatment was administered in 2 cases: 1 patient diagnosed with an isolated left sacral fracture and another diagnosed with sacral 1 and 2 fractures, accompanied by a left pubic fracture. In both instances, symptoms improved more rapidly than the anticipated immobilization period, allowing for an early return to daily activities. We also observed that the radiological follow-up changes yielded significant treatment results.

1. Treatment methods

1) Acupuncture

Acupuncture treatment involved the use of needles (0.20 × 30 mm or 0.25 × 30 mm, disposable sterilized stainless steel; Dongbang Medical Co., Ltd.), left in position for 15 minutes. The treatment was performed twice daily, in the mornings and afternoons, using acupoints selected from bilateral BL23, BL24, BL25, BL26, BL27, BL28, BL31, BL32, BL33, BL34, BL52, and GB30. For Case 2, which included a left pubic fracture, acupoints were chosen from bilateral CV2, CV3, and KI11.

2) Acupotomy

Acupotomy treatment was administered solely in Case 2, using an acupotomy needle 0.75 × 80 mm (disposable sterilized stainless steel, Dongbang Medical Co., Ltd.). Prior to treatment, the possible side effects and precautions were explained, and a signed informed consent form was obtained from the patient (Appendix A). The treatment was performed 4–5 times a week, 23 times in total, once at 9 AM. The adhesive and the hard and soft tissues of the erector spinae muscle near acupuncture points BL24 and BL25 were treated.

3) Pharmacopuncture

Pharmacopuncture was carried out with a disposable syringe 1 mL, 26 G × 13 mm syringe (Becton, Dickinson and Company) and a sterilized needle 30 G × 39 mm (Sungshim Medical Co., Ltd.). So-yeom pharmacopuncture 2 mL (Korean Pharmacopuncture Research Institute) was performed 3–4 times a week in Case 1 and twice a week in Case 2. Cho-o pharmacopuncture 2 mL (Kirin Korean Medicine Industrial Institute,) was administered 4–5 times a week in Case 2. Pharmacopuncture was injected into the acupoints chosen from bilateral BL23, BL24, and BL25, with a total volume of 2 mL, 0.5 mL per acupoint.

4) Herbal medicine

Herbal medicine was provided in 3 daily packs (120 mL per pack), taken 1 hour after each meal. Tables 1 and 2 show the duration and composition of the herbal medicines prescribed during the hospitalization period in both cases.

Table 1 . Duration and composition of herbal medicines in Case 1

Dangguisu-san Gami, 2023.2.3. (admission) (1 d)Dose (g)Dangguisu-san, 2023.2.4.–2023.2.8. (day 2–6) (5 d)Dose (g)Gami gunggui-tang, 2023.2.9.–2023.3.3. (day 7-discharge) (23 d)Dose (g)
Angelicae Gigantis Radix6Rehmanniae Radix Recens8Angelicae Gigantis Radix20
Paeoniae Radix4Angelicae Gigantis Radix6Cnidii Rhizoma20
Linderae Radix4Paeoniae Radix4Astragali Radix8
Cyperi Rhizoma4Linderae Radix4Ginseng Radix8
Sappan Lignum4Cyperi Rhizoma4Lycii Fructus8
Carthami Flos3Sappan Lignum4Codonopsis Pilosulae Radix4
Persicae Semen3Carthami Flos2Cuscutae Semen4
Cassiae Cortex Interior2Persicae Semen2Dipsaci Radix4
Glycyrrhizae Radix et Rhizoma2Cinnamomi Ramulus2Dendrobii Caulis4
Glycyrrhizae Radix et Rhizoma2Eucommiae Cortex4
Rhei Radix et Rhizoma2Drynariae Rhizoma4
Carthami Flos4

Table 2 . Duration and composition of herbal medicines in Case 2

Pyeongjingeonbi-tang, 2023.2.8.–2023.2.13., 2023.2.17., 2023.2.22.–2023.2.23. (admission-day 6, day 10, day 15-day 16) (9 d)Dose (g)Gami gunggui-tang, 2023.2.14.–2023.2.16., 2023.2.18.–2023.2.21. (day 7–9, day 11–14) (7 d)Dose (g)Gami yangwi-tang, 2023.2.24. (day 17) (1 d)Dose (g)Sipjeondaebotang-Gagambang, 2023.2.25.–2023.3.21. (day 18-discharge) (25 d)Dose (g)
Crataegii Fructus6Angelicae Gigantis Radix20Atractylodis Rhizoma8Ginseng Radix5
Cyperi Rhizoma4Cnidii Rhizoma20Magnoliae Cortex4Atractylodis Rhizoma Alba5
Pinelliae Tuber4Astragali Radix8Citri Unshius Pericarpium4Poria Sclerotium5
Citri Unshius Pericarpium4Ginseng Radix4Polyporus4Glycyrrhizae Radix et Rhizoma5
Cnidii Rhizoma4Lycii Fructus8Alismatis Rhizoma4Paeoniae Radix5
Atractylodis Rhizoma4Codonopsis Pilosulae Radix4Poria Sclerotium4Cnidii Rhizoma5
Atractylodis Rhizoma Alba4Cuscutae Semen4Agastachis Herba4Angelicae Gigantis Radix4
Ponciri Fructus Immaturus4Dipsaci Radix4Poria Sclerotium4Astragali Radix4
Agastachis Herba4Dendrobii Caulis4Zingiberis Rhizoma4Longan Arillus4
Magnoliae Cortex4Eucommiae Cortex4Cinnamomi Ramulus4Atractylodis Rhizoma4
Amomi Fructus4Drynariae Rhizoma4Aucklandiae Radix4Citri Unshius Pericarpium4
Massa Medicata Fermentata6Cervi Cornu4Zingiberis Rhizoma Recens4Magnoliae Cortex4
Hordei Fructus Germinatus6Zizyphi Fructus6Cyperi Rhizoma4
Glycyrrhizae Radix et Rhizoma4Cyperi Rhizoma6Pinelliae Tuber4
Aucklandiae Radix2Ponciri Fructus Immaturus6Crataegii Fructus4
Zingiberis Rhizoma Recens12Crataegii Fructus4Drynariae Rhizoma4
Zizyphi Fructus8Amomi Fructus4
Longan Arillus8

5) Moxibustion

During the absolute bed rest (ABR) phase, indirect electric moxibustion therapy (Technoscience) was applied at BL23 once daily for 15 minutes. During the bed rest (BR) phase, indirect moxibustion using charcoal moxa cones (Dongbang Medical Co., Ltd.) was administered at BL23 once daily for 30 minutes.

6) Cupping therapy

Dry cupping therapy was conducted in the lumbosacral region using a manual vacuum pump for 3 minutes. It was performed twice daily during the ABR phase and once daily during the BR phase.

2. Evaluation

1) Numerical rating scale

The numerical rating scale (NRS) scores is used to quantify the subjective severity of pain on a scale of 0 to 10. A score of 10 represents the worst imaginable pain, while 0 indicates a pain-free state [12]. The evaluation was conducted daily at 7 AM.

2) Range of motion

Range of motion (ROM) assesses the lumbar spine’s ROM and the presence of pain during active movement. The angles of flexion, extension, lateral bending, and rotation of the lumbar spine were measured daily at 7 AM. A “+” sign was marked if pain was noted during movement.

3) Changes in gait and walking distance

The patient’s ability to move via wheelchair, walker, or independent ambulation was evaluated. The number of roundtrips made in an approximately 80-m-long hospital corridor was recorded.

4) X-ray and computed tomography

Radiological images were taken after roughly 3 weeks of integrative Korean medicine treatment and were subsequently reviewed by a radiologist.

3. Case 1

1) Patient

Female, 67 years old.

2) Principal complaints

Lumbosacral pain.

3) Onset and cause

The patient experienced pain subsequent to a traffic accident that occurred while crossing the crosswalk on February 3, 2023.

4) Present illness

On February 3, 2023, a hospital-conducted X-ray of the lumbar spine revealed no notable findings, and subsequently, the patient was then admitted to the hospital. On February 7, 2023, a lumbar spine computed tomography (CT) performed at the hospital led to the diagnosis of a left sacral fracture.

5) Progress

Upon admission, lumbosacral pain was rated at NRS 7.5, and the patient experienced difficulty sitting in a wheelchair, although ambulation was possible. Acetaminophen 325 mg and tramadol hydrochloride (HCl) 37.5 mg were administered after breakfast and dinner, leading to hospitalization with BR. On day 5, the pain persisted, and a lumbar spine CT revealed a left sacral fracture. The patient was then advised to apply ABR; however, the pain continued. Aceclofenac 100 mg and eperisone HCl 50 mg were additionally administered after breakfast and dinner from days 12 to 20. On day 14, the lumbosacral pain was still NRS 7.5, but the patient could walk 40 m with a walker. By day 21, the pain decreased to NRS 5.5, and acetaminophen 162.5 mg, tramadol HCl 18.75 mg, aceclofenac 100 mg, and eperisone HCl 50 mg were administered after breakfast and dinner until day 26. On day 25, the pain further decreased to NRS 4, and the patient could walk 160 m with the walker. Following this, the patient was advised to transition from ABR to BR. From day 27 to discharge, aceclofenac 100 mg and eperisone HCl 50 mg were administered after breakfast and dinner, causing the lumbosacral pain to increase to NRS 6. Upon discharge, the patient could walk independently, but the pain increased to NRS 7. In addition to the oral analgesics described above, diclofenac sodium 37.5 mg or tramadol HCl 25 mg were administered intramuscularly when necessary (Figs. 1, 2; Table 3).

Table 3 . Medications administered during Case 1’s hospitalization

Medication2023.2.4.–2023.2.13. (day 2–11) (10 d)2023.2.14.–2023.2.22. (day 12–20) (9 d)2023.2.23.–2023.2.28. (day 21–26) (6 d)2023.3.1.–2023.3.3. (day 27-discharge) (3 d)
Acetaminophen 325 mg, tramadol HCl 37.5 mgB, D/PC 30 minB, D/PC 30 min--
Acetaminophen 162.5 mg, tramadol HCl 18.75 mgB, D/PC 30 min-
Aceclofenac 100 mgB, D/PC 30 minB, D/PC 30 minB, D/PC 30 min
Eperisone HCl 50 mgB, D/PC 30 minB, D/PC 30 minB, D/PC 30 min
Diclofenac sodium 37.5 mg02/11 1/d
02/12 2/d
---
Tramodol HCl 25 mg02/14 1/d
02/16 1/d
--

HCl, hydrochloride; B, D/PC 30 min, breakfast, dinner/post-cibum 30 minutes; -, not applicable.


Fig. 1. Changes in Case 1’s NRS score over time. NRS, numerical rating scale.
Fig. 2. Case 1. Changes in gait and walking distance. ABR, absolute bed rest; CT, computed tomography; BR, bed rest.

At the time of admission, the ROM of the lumbar spine could not be measured due to pain. However, at discharge, the ROM of the lumbar spine was measured with flexion at 80° (+) and extension at 20° (+), while lateral bending and rotation were within the normal range (Table 4).

Table 4 . Changes in Case 1’s range of motion (before and after treatment)

Lumbar spine ROM2023.2.3. (before treatment)2023.3.3. (after treatment)
FlexionUnable to measure because of pain80° (+)
ExtensionUnable to measure because of pain20° (+)
Lateral bendingUnable to measure because of pain35°/35°
RotationUnable to measure because of pain45°/45°

ROM, range of motion; +, sign was marked when there was pain while moving.


6) Radiological findings

On day 2, the patient was diagnosed with a left sacral fracture via a lumbar spine CT scan, and on day 25, a pelvic bone CT showed decreased dislocation of the left sacral fracture (Fig. 3). An X-ray of the lumbosacral spine revealed no sacral fracture. On March 14, 2023, after the patient was discharged, an X-ray of the lumbosacral spine was taken during an outpatient visit to the hospital. The resultant films revealed progressive fusion of the fracture. On April 21, 2023, an X-ray of the sacrococcygeal spine showed additional fusion (Fig. 4).

Fig. 3. Case 1. The figures show the left sacral fracture. (A) Lumbar spine CT (2023.2.4., day 2) and (B) pelvic bone CT (2023.2.27., day 25). The arrows indicate the fracture site. CT, computed tomography.
Fig. 4. Case 1. The figures show the left sacral fracture. (A) X-ray of the lumbosacral spine (2023.2.4., day 2), (B) X-ray of the lumbosacral spine (2023.3.14.), and (C) X-ray of the sacrococcygeal spine (2023.4.21.). The arrows indicate the fracture site.

4. Case 2

1) Patient

Female, 69 years old.

2) Principal complaints

Lumbosacral and lower extremity pain.

3) Onset and cause

The patient fell on December 22, 2022. By January 24, 2023, her symptoms had worsened, particularly when upright.

4) Present illness

On February 1, 2023, the patient was diagnosed with fractures in sacrum 1 and 2 through a lumbar spine CT scan at the hospital. On February 7, 2023, the patient was found to have a herniated nucleus pulposus (HNP) of L4–5 and spinal stenosis of L4–5 via a lumbar spine magnetic resonance imaging, as well as fractures in sacrum 1, 2, and the left pubic bone as revealed by a pelvic bone CT scan at the hospital. The patient was hospitalized on February 8, 2023.

5) Progress

Upon admission, the patient’s lumbosacral pain was rated NRS 4 and lower extremity pain was rated NRS 8, making ambulation possible only by wheelchair. The patient struggled to sit in the wheelchair and was hospitalized with ABR, receiving acetaminophen 162.5 mg, tramadol HCl 18.75 mg, aceclofenac 100 mg, and eperisone 75 mg after breakfast and dinner. By day 3, the patient could move 160 m while seated in the wheelchair, leading to a recommendation to shift from ABR to BR. On day 7, the lumbosacral pain subsided to NRS 1.5, and lower extremity pain dropped to NRS 4. The medication was adjusted to include acetaminophen 162.5 mg, tramadol HCl 18.75 mg, aceclofenac 100 mg, and eperisone HCl 50 mg after meals until day 13. On day 14, the lumbosacral pain remained NRS 1.5, and lower extremity pain further decreased to NRS 3. Aceclofenac 100 mg and eperisone HCl 50 mg were then prescribed after breakfast and dinner until day 20. From day 21 until discharge, analgesics were halted, and on day 28, lumbosacral pain lessened to NRS 1, while lower extremity pain rose to NRS 6. On day 31, the patient could walk 40 m with a walker, and from day 35, the patient could walk 160 m. The average daily distance walked with a walker increased from 424 m to 720 m by discharge. From day 37 until discharge, lumbosacral pain was stable at NRS 1, and lower extremity pain was NRS 2 (Figs. 5, 6; Table 5).

Table 5 . Medications administered during Case 2’s hospitalization

Medication2023.2.8.–2023.2.13. (admission-day 6) (6 d)2023.2.14.–2023.2.20. (day 7–13) (7 d)2023.2.21.–2023.2.27. (day 14–20) (7 d)2023.2.28.–2023.3.21. (day 21-discharge) (22 d)
Acetaminophen 162.5 mg, tramadol HCl 18.75 mgB, D/PC 30 minB, D/PC 30 min--
Aceclofenac 100 mgB, D/PC 30 minB, D/PC 30 minB, D/PC 30 min-
Eperisone HCl 75 mgB, D/PC 30 min---
Eperisone HCl 50 mgB, D/PC 30 minB, D/PC 30 min-

HCl, hydrochloride; B, D/PC 30 min, breakfast, dinner/post-cibum 30 minutes; -, not applicable.


Fig. 5. Case 2. Changes in the NRS score over time. NRS, numerical rating scale.
Fig. 6. Case 2. Changes in gait and walking distance. CT, computed tomography; ABR, absolute bed rest; BR, bed rest.

At admission, lumbar spine ROM was measured with extension at 0° (+) and lateral bending at 30° (+), with flexion and rotation within the normal range. At discharge, extension was measured at 20° (+), and all other measures were within the normal range (Table 6).

Table 6 . Changes in Case 2’s range of motion (before and after treatment)

Lumbar spine ROM2023.2.8. (before treatment)2023.3.21. (after treatment)
Flexion80°80°
Extension0° (+)20° (+)
Lateral bending30° (+)/30° (+)35°/35°
Rotation45°/45°45°/45°

ROM, range of motion; +, pain while moving.


6) Radiological findings

On February 7, 2023, the patient was diagnosed with fractures in sacrum 1 and 2 through a pelvic bone CT scan at the hospital. On day 3, an X-ray of the lumbar spine revealed a dislocation of the sacrum 1 and 2 fractures. On day 24, a subsequent X-ray of the lumbar spine showed progressive fusion of the fractures in sacrum 1 and 2 (Fig. 7).

Fig. 7. Case 2. The figures show sacrum 1 and 2 fractures. (A) Pelvic bone CT (2023.2.7.), (B) X-ray of the lumbar spine (2023.2.10., day 3), and (C) X-ray of the lumbar spine (2023.3.3., day 24). The arrows indicate the fracture site.

Sacral fractures are typically treated conservatively unless structural stability is lost, or neurological abnormalities occur [11]. Conventional conservative treatments include BR and mechanical traction. Integrative Korean medicine is known for reducing pain and promoting fracture fusion [13].

Acupuncture is effective in controlling pain, restoring ROM, and preventing stiffness [14]. Acupotomy was also performed in Case 2, as the patient was diagnosed with a HNP of L4–5 and spinal stenosis of L4–5 and had lower extremity pain. Lower extremity pain is a key symptom of HNP and spinal stenosis and began after the patient’s fall. However, HNP and spinal stenosis are often chronic conditions believed to have started before the patient’s fall [15]. Therefore, it seems the fall worsened the patient’s HNP of L4–5 and spinal stenosis of L4–5, revealing the lower extremity pain. Acupotomy is typically used for chronic pain. A past study found acupotomy effective for reducing pain and improving lumbar spine ROM and quality of life in patients with acute lumbosacral pain caused by trauma [16]. Pharmacopuncture combines acupuncture medicine and pharmacotherapy [17]. So-yeom pharmacopuncture exerts anti-inflammatory effects by inhibiting inflammation-related tumor necrosis factor α and interferon γ [18]. Aconitine, the main component of Cho-o pharmacopuncture, demonstrates strong anti-inflammatory and analgesic effects [19]. Depending on the patient’s symptoms, prescriptions of Dagguisu-san, Gami gunggui-tang, and Sipjeondaebotang-Gagambang were made, each with specific and unique efficacies. Dagguisu-san treats early-stage blood stasis and Gami gunggui-tang boosts energy to promote later-stage fracture fusion [20]. Sipjeondaebotang-Gagambang increases blood supply to promote fracture fusion and treats post-traumatic inertia [21]. Case 2 was prescribed Pyeongjingeonbi-tang and Gami yangwi-tang for dyspepsia and vomiting during hospitalization. Moxibustion improves circulation by heating acupoints, and dry cupping relieves pain and removes blood stasis [22].

Case 1 demonstrated improved ROM and could walk independently about 4 weeks (29 days), faster than the typical 6 weeks of immobilization in patients with moderate sacral fractures [23]. Case 2 had a lower NRS score, improved ROM, and could walk independently in 7 weeks (49 days), faster than the expected > 8 week immobilization period for severe sacral and pubic fractures [23]. Integrative Korean medicine treatment is beneficial for patients with sacral fractures by reducing lumbosacral pain while improving ROM. Additionally, radiological examinations taken before and after treatment showed progressive fusion of the fracture in both cases.

However, our results should be interpreted with caution due to several limitations. First, the cases in this study may appear heterogeneous since Case 2 also involved a pubic fracture. Yet, this left pubic fracture was classified as Tile-type A2, signifying a minimally displaced fracture without instability, and the patient did not feel pain in that region [11]. Thus, the study’s results could be considered in the context of integrative Korean medicine treatment for sacral fractures. Second, in Case 1, lumbar spine ROM improved; however, the degree of improvement was non-significant (NRS: 7.5 at admission and 7 at discharge). Conversely, in Case 2, both ROM and NRS scores improved markedly. Since the patients under BR were also undergoing walking rehabilitation to assess their ambulatory status during hospitalization, detecting NRS score changes was challenging. Nevertheless, the treatment appeared effective, as the patients ceased taking analgesics and could walk independently upon discharge. Third, this study includes only 2 cases, and in Case 2, no follow-up was conducted after discharge. Fourth, interpreting the effect of integrative Korean medicine treatment is complex due to analgesics administration and the natural healing ability of non-displaced fractures within 4–6 weeks of BR [1]. Lastly, the NRS score for lower extremity pain dropped (NRS: 8 at admission and 2 at discharge), yet isolating the effect of acupotomy treatment in Case 2 is challenging since other treatments were also applied. However, this result confirms the potential of acupotomy in treating acute lumbosacral and lower extremity pain, an area where studies remain scarce. Overall, a systematic follow-up study with a larger sample population is essential to objectively evaluate the efficacy of integrative Korean medicine treatment for sacral fractures.

Conceptualization: YSK, YIK. Methodology: YSK. Formal investigation: YSK. Data analysis: YSK. Writing – original draft: YSK. Writing – review & editing: All authors.

This study was exempt from the Daejeon Korean Medicine Hospital of Daejeon University Institutional Review Board (IRB no.: DJDSKH-23-E-12).

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Article

Case Report

Journal of Acupuncture Research 2023; 40(3): 281-292

Published online August 31, 2023 https://doi.org/10.13045/jar.2023.00171

Copyright © Korean Acupuncture & Moxibustion Medicine Society.

Integrative Korean Medicine Treatment for Sacral Fracture: Two Clinical Cases

Yeon Soo Kang , Pil Je Park , So Jeong Kim , Hyun Jin Jang , Min Ju Kim , Hyeon Kyu Choi , Jeong Kyo Jeong , Ju Hyun Jeon , Young Il Kim

Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Korea

Correspondence to:Young Il Kim
Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, 75, Daedeok-daero 176beon-gil, Seo-gu, Daejeon 35235, Korea
E-mail: omdkim01@dju.kr

Received: July 22, 2023; Revised: August 12, 2023; Accepted: August 15, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This study presents the cases of a 67-year-old female with an isolated left sacral fracture and a 69-year-old female with fractures in sacrum 1, 2, and the left pubic bone. Both patients exhibited marked improvement following integrative Korean medicine treatment, encompassing acupuncture, acupotomy, pharmacopuncture, herbal medicine, moxibustion, and cupping therapy. The treatment’s efficacy was assessed using the numerical rating scale (NRS) scores, range of motion (ROM) in the lumbar spine, and alterations in gait and walking distance. Case 1 demonstrated an enhanced ROM and achieved independent walking after 29 days of treatment. Case 2 improved in both ROM and NRS score and could walk independently after 49 days of treatment. Significantly, radiological images showed notable changes in both cases following treatments. The study indicates that integrative Korean medicine treatment could provide clinical advantages to individuals suffering from sacral fractures.

Keywords: Acupotomy, Acupuncture, Herbal medicine, Korean traditional medicine, Pharmacopuncture, Spinal fractures

INTRODUCTION

Most sacral fractures are the result of an external force exerted on the pelvis or spine, typically associated with other fractures [1]. They can lead to pelvic ring or spine-pelvis instability, with 25% of such fractures causing nerve injury due to the location of the lumbosacral plexus [2-4]. Radiologically, sacral fractures can be challenging to detect and often present no typical clinical symptoms [4-6]. Concurrent injuries may conceal nerve damage, delaying diagnosis in approximately 30% of sacral fractures if not identified and managed properly [2-8].

Treatment for sacral fractures may be surgical or conservative, depending on the stability of the pelvic fracture and the presence of neurological symptoms [4]. However, a clear consensus on treatment methods and principles is lacking, therefore conservative treatment typically employed if the fracture region does not include unstable pelvic fractures or neurological disorders [1,9].

Studies by Lee et al. [10] and Ha et al. [11] have shown that integrative Korean medicine treatment significantly impacts patients with both sacral and multiple fractures. This makes it challenging to ascertain the specific efficacy of integrative Korean medicine on isolated sacral fractures alone. Moreover, there are no case reports or studies concerning the effect of Korean medicine treatment on isolated sacral fractures or associated radiological changes.

In the present study, integrative Korean medicine treatment was administered in 2 cases: 1 patient diagnosed with an isolated left sacral fracture and another diagnosed with sacral 1 and 2 fractures, accompanied by a left pubic fracture. In both instances, symptoms improved more rapidly than the anticipated immobilization period, allowing for an early return to daily activities. We also observed that the radiological follow-up changes yielded significant treatment results.

CASE REPORT

1. Treatment methods

1) Acupuncture

Acupuncture treatment involved the use of needles (0.20 × 30 mm or 0.25 × 30 mm, disposable sterilized stainless steel; Dongbang Medical Co., Ltd.), left in position for 15 minutes. The treatment was performed twice daily, in the mornings and afternoons, using acupoints selected from bilateral BL23, BL24, BL25, BL26, BL27, BL28, BL31, BL32, BL33, BL34, BL52, and GB30. For Case 2, which included a left pubic fracture, acupoints were chosen from bilateral CV2, CV3, and KI11.

2) Acupotomy

Acupotomy treatment was administered solely in Case 2, using an acupotomy needle 0.75 × 80 mm (disposable sterilized stainless steel, Dongbang Medical Co., Ltd.). Prior to treatment, the possible side effects and precautions were explained, and a signed informed consent form was obtained from the patient (Appendix A). The treatment was performed 4–5 times a week, 23 times in total, once at 9 AM. The adhesive and the hard and soft tissues of the erector spinae muscle near acupuncture points BL24 and BL25 were treated.

3) Pharmacopuncture

Pharmacopuncture was carried out with a disposable syringe 1 mL, 26 G × 13 mm syringe (Becton, Dickinson and Company) and a sterilized needle 30 G × 39 mm (Sungshim Medical Co., Ltd.). So-yeom pharmacopuncture 2 mL (Korean Pharmacopuncture Research Institute) was performed 3–4 times a week in Case 1 and twice a week in Case 2. Cho-o pharmacopuncture 2 mL (Kirin Korean Medicine Industrial Institute,) was administered 4–5 times a week in Case 2. Pharmacopuncture was injected into the acupoints chosen from bilateral BL23, BL24, and BL25, with a total volume of 2 mL, 0.5 mL per acupoint.

4) Herbal medicine

Herbal medicine was provided in 3 daily packs (120 mL per pack), taken 1 hour after each meal. Tables 1 and 2 show the duration and composition of the herbal medicines prescribed during the hospitalization period in both cases.

Table 1 . Duration and composition of herbal medicines in Case 1.

Dangguisu-san Gami, 2023.2.3. (admission) (1 d)Dose (g)Dangguisu-san, 2023.2.4.–2023.2.8. (day 2–6) (5 d)Dose (g)Gami gunggui-tang, 2023.2.9.–2023.3.3. (day 7-discharge) (23 d)Dose (g)
Angelicae Gigantis Radix6Rehmanniae Radix Recens8Angelicae Gigantis Radix20
Paeoniae Radix4Angelicae Gigantis Radix6Cnidii Rhizoma20
Linderae Radix4Paeoniae Radix4Astragali Radix8
Cyperi Rhizoma4Linderae Radix4Ginseng Radix8
Sappan Lignum4Cyperi Rhizoma4Lycii Fructus8
Carthami Flos3Sappan Lignum4Codonopsis Pilosulae Radix4
Persicae Semen3Carthami Flos2Cuscutae Semen4
Cassiae Cortex Interior2Persicae Semen2Dipsaci Radix4
Glycyrrhizae Radix et Rhizoma2Cinnamomi Ramulus2Dendrobii Caulis4
Glycyrrhizae Radix et Rhizoma2Eucommiae Cortex4
Rhei Radix et Rhizoma2Drynariae Rhizoma4
Carthami Flos4

Table 2 . Duration and composition of herbal medicines in Case 2.

Pyeongjingeonbi-tang, 2023.2.8.–2023.2.13., 2023.2.17., 2023.2.22.–2023.2.23. (admission-day 6, day 10, day 15-day 16) (9 d)Dose (g)Gami gunggui-tang, 2023.2.14.–2023.2.16., 2023.2.18.–2023.2.21. (day 7–9, day 11–14) (7 d)Dose (g)Gami yangwi-tang, 2023.2.24. (day 17) (1 d)Dose (g)Sipjeondaebotang-Gagambang, 2023.2.25.–2023.3.21. (day 18-discharge) (25 d)Dose (g)
Crataegii Fructus6Angelicae Gigantis Radix20Atractylodis Rhizoma8Ginseng Radix5
Cyperi Rhizoma4Cnidii Rhizoma20Magnoliae Cortex4Atractylodis Rhizoma Alba5
Pinelliae Tuber4Astragali Radix8Citri Unshius Pericarpium4Poria Sclerotium5
Citri Unshius Pericarpium4Ginseng Radix4Polyporus4Glycyrrhizae Radix et Rhizoma5
Cnidii Rhizoma4Lycii Fructus8Alismatis Rhizoma4Paeoniae Radix5
Atractylodis Rhizoma4Codonopsis Pilosulae Radix4Poria Sclerotium4Cnidii Rhizoma5
Atractylodis Rhizoma Alba4Cuscutae Semen4Agastachis Herba4Angelicae Gigantis Radix4
Ponciri Fructus Immaturus4Dipsaci Radix4Poria Sclerotium4Astragali Radix4
Agastachis Herba4Dendrobii Caulis4Zingiberis Rhizoma4Longan Arillus4
Magnoliae Cortex4Eucommiae Cortex4Cinnamomi Ramulus4Atractylodis Rhizoma4
Amomi Fructus4Drynariae Rhizoma4Aucklandiae Radix4Citri Unshius Pericarpium4
Massa Medicata Fermentata6Cervi Cornu4Zingiberis Rhizoma Recens4Magnoliae Cortex4
Hordei Fructus Germinatus6Zizyphi Fructus6Cyperi Rhizoma4
Glycyrrhizae Radix et Rhizoma4Cyperi Rhizoma6Pinelliae Tuber4
Aucklandiae Radix2Ponciri Fructus Immaturus6Crataegii Fructus4
Zingiberis Rhizoma Recens12Crataegii Fructus4Drynariae Rhizoma4
Zizyphi Fructus8Amomi Fructus4
Longan Arillus8

5) Moxibustion

During the absolute bed rest (ABR) phase, indirect electric moxibustion therapy (Technoscience) was applied at BL23 once daily for 15 minutes. During the bed rest (BR) phase, indirect moxibustion using charcoal moxa cones (Dongbang Medical Co., Ltd.) was administered at BL23 once daily for 30 minutes.

6) Cupping therapy

Dry cupping therapy was conducted in the lumbosacral region using a manual vacuum pump for 3 minutes. It was performed twice daily during the ABR phase and once daily during the BR phase.

2. Evaluation

1) Numerical rating scale

The numerical rating scale (NRS) scores is used to quantify the subjective severity of pain on a scale of 0 to 10. A score of 10 represents the worst imaginable pain, while 0 indicates a pain-free state [12]. The evaluation was conducted daily at 7 AM.

2) Range of motion

Range of motion (ROM) assesses the lumbar spine’s ROM and the presence of pain during active movement. The angles of flexion, extension, lateral bending, and rotation of the lumbar spine were measured daily at 7 AM. A “+” sign was marked if pain was noted during movement.

3) Changes in gait and walking distance

The patient’s ability to move via wheelchair, walker, or independent ambulation was evaluated. The number of roundtrips made in an approximately 80-m-long hospital corridor was recorded.

4) X-ray and computed tomography

Radiological images were taken after roughly 3 weeks of integrative Korean medicine treatment and were subsequently reviewed by a radiologist.

3. Case 1

1) Patient

Female, 67 years old.

2) Principal complaints

Lumbosacral pain.

3) Onset and cause

The patient experienced pain subsequent to a traffic accident that occurred while crossing the crosswalk on February 3, 2023.

4) Present illness

On February 3, 2023, a hospital-conducted X-ray of the lumbar spine revealed no notable findings, and subsequently, the patient was then admitted to the hospital. On February 7, 2023, a lumbar spine computed tomography (CT) performed at the hospital led to the diagnosis of a left sacral fracture.

5) Progress

Upon admission, lumbosacral pain was rated at NRS 7.5, and the patient experienced difficulty sitting in a wheelchair, although ambulation was possible. Acetaminophen 325 mg and tramadol hydrochloride (HCl) 37.5 mg were administered after breakfast and dinner, leading to hospitalization with BR. On day 5, the pain persisted, and a lumbar spine CT revealed a left sacral fracture. The patient was then advised to apply ABR; however, the pain continued. Aceclofenac 100 mg and eperisone HCl 50 mg were additionally administered after breakfast and dinner from days 12 to 20. On day 14, the lumbosacral pain was still NRS 7.5, but the patient could walk 40 m with a walker. By day 21, the pain decreased to NRS 5.5, and acetaminophen 162.5 mg, tramadol HCl 18.75 mg, aceclofenac 100 mg, and eperisone HCl 50 mg were administered after breakfast and dinner until day 26. On day 25, the pain further decreased to NRS 4, and the patient could walk 160 m with the walker. Following this, the patient was advised to transition from ABR to BR. From day 27 to discharge, aceclofenac 100 mg and eperisone HCl 50 mg were administered after breakfast and dinner, causing the lumbosacral pain to increase to NRS 6. Upon discharge, the patient could walk independently, but the pain increased to NRS 7. In addition to the oral analgesics described above, diclofenac sodium 37.5 mg or tramadol HCl 25 mg were administered intramuscularly when necessary (Figs. 1, 2; Table 3).

Table 3 . Medications administered during Case 1’s hospitalization.

Medication2023.2.4.–2023.2.13. (day 2–11) (10 d)2023.2.14.–2023.2.22. (day 12–20) (9 d)2023.2.23.–2023.2.28. (day 21–26) (6 d)2023.3.1.–2023.3.3. (day 27-discharge) (3 d)
Acetaminophen 325 mg, tramadol HCl 37.5 mgB, D/PC 30 minB, D/PC 30 min--
Acetaminophen 162.5 mg, tramadol HCl 18.75 mgB, D/PC 30 min-
Aceclofenac 100 mgB, D/PC 30 minB, D/PC 30 minB, D/PC 30 min
Eperisone HCl 50 mgB, D/PC 30 minB, D/PC 30 minB, D/PC 30 min
Diclofenac sodium 37.5 mg02/11 1/d
02/12 2/d
---
Tramodol HCl 25 mg02/14 1/d
02/16 1/d
--

HCl, hydrochloride; B, D/PC 30 min, breakfast, dinner/post-cibum 30 minutes; -, not applicable..


Figure 1. Changes in Case 1’s NRS score over time. NRS, numerical rating scale.
Figure 2. Case 1. Changes in gait and walking distance. ABR, absolute bed rest; CT, computed tomography; BR, bed rest.

At the time of admission, the ROM of the lumbar spine could not be measured due to pain. However, at discharge, the ROM of the lumbar spine was measured with flexion at 80° (+) and extension at 20° (+), while lateral bending and rotation were within the normal range (Table 4).

Table 4 . Changes in Case 1’s range of motion (before and after treatment).

Lumbar spine ROM2023.2.3. (before treatment)2023.3.3. (after treatment)
FlexionUnable to measure because of pain80° (+)
ExtensionUnable to measure because of pain20° (+)
Lateral bendingUnable to measure because of pain35°/35°
RotationUnable to measure because of pain45°/45°

ROM, range of motion; +, sign was marked when there was pain while moving..


6) Radiological findings

On day 2, the patient was diagnosed with a left sacral fracture via a lumbar spine CT scan, and on day 25, a pelvic bone CT showed decreased dislocation of the left sacral fracture (Fig. 3). An X-ray of the lumbosacral spine revealed no sacral fracture. On March 14, 2023, after the patient was discharged, an X-ray of the lumbosacral spine was taken during an outpatient visit to the hospital. The resultant films revealed progressive fusion of the fracture. On April 21, 2023, an X-ray of the sacrococcygeal spine showed additional fusion (Fig. 4).

Figure 3. Case 1. The figures show the left sacral fracture. (A) Lumbar spine CT (2023.2.4., day 2) and (B) pelvic bone CT (2023.2.27., day 25). The arrows indicate the fracture site. CT, computed tomography.
Figure 4. Case 1. The figures show the left sacral fracture. (A) X-ray of the lumbosacral spine (2023.2.4., day 2), (B) X-ray of the lumbosacral spine (2023.3.14.), and (C) X-ray of the sacrococcygeal spine (2023.4.21.). The arrows indicate the fracture site.

4. Case 2

1) Patient

Female, 69 years old.

2) Principal complaints

Lumbosacral and lower extremity pain.

3) Onset and cause

The patient fell on December 22, 2022. By January 24, 2023, her symptoms had worsened, particularly when upright.

4) Present illness

On February 1, 2023, the patient was diagnosed with fractures in sacrum 1 and 2 through a lumbar spine CT scan at the hospital. On February 7, 2023, the patient was found to have a herniated nucleus pulposus (HNP) of L4–5 and spinal stenosis of L4–5 via a lumbar spine magnetic resonance imaging, as well as fractures in sacrum 1, 2, and the left pubic bone as revealed by a pelvic bone CT scan at the hospital. The patient was hospitalized on February 8, 2023.

5) Progress

Upon admission, the patient’s lumbosacral pain was rated NRS 4 and lower extremity pain was rated NRS 8, making ambulation possible only by wheelchair. The patient struggled to sit in the wheelchair and was hospitalized with ABR, receiving acetaminophen 162.5 mg, tramadol HCl 18.75 mg, aceclofenac 100 mg, and eperisone 75 mg after breakfast and dinner. By day 3, the patient could move 160 m while seated in the wheelchair, leading to a recommendation to shift from ABR to BR. On day 7, the lumbosacral pain subsided to NRS 1.5, and lower extremity pain dropped to NRS 4. The medication was adjusted to include acetaminophen 162.5 mg, tramadol HCl 18.75 mg, aceclofenac 100 mg, and eperisone HCl 50 mg after meals until day 13. On day 14, the lumbosacral pain remained NRS 1.5, and lower extremity pain further decreased to NRS 3. Aceclofenac 100 mg and eperisone HCl 50 mg were then prescribed after breakfast and dinner until day 20. From day 21 until discharge, analgesics were halted, and on day 28, lumbosacral pain lessened to NRS 1, while lower extremity pain rose to NRS 6. On day 31, the patient could walk 40 m with a walker, and from day 35, the patient could walk 160 m. The average daily distance walked with a walker increased from 424 m to 720 m by discharge. From day 37 until discharge, lumbosacral pain was stable at NRS 1, and lower extremity pain was NRS 2 (Figs. 5, 6; Table 5).

Table 5 . Medications administered during Case 2’s hospitalization.

Medication2023.2.8.–2023.2.13. (admission-day 6) (6 d)2023.2.14.–2023.2.20. (day 7–13) (7 d)2023.2.21.–2023.2.27. (day 14–20) (7 d)2023.2.28.–2023.3.21. (day 21-discharge) (22 d)
Acetaminophen 162.5 mg, tramadol HCl 18.75 mgB, D/PC 30 minB, D/PC 30 min--
Aceclofenac 100 mgB, D/PC 30 minB, D/PC 30 minB, D/PC 30 min-
Eperisone HCl 75 mgB, D/PC 30 min---
Eperisone HCl 50 mgB, D/PC 30 minB, D/PC 30 min-

HCl, hydrochloride; B, D/PC 30 min, breakfast, dinner/post-cibum 30 minutes; -, not applicable..


Figure 5. Case 2. Changes in the NRS score over time. NRS, numerical rating scale.
Figure 6. Case 2. Changes in gait and walking distance. CT, computed tomography; ABR, absolute bed rest; BR, bed rest.

At admission, lumbar spine ROM was measured with extension at 0° (+) and lateral bending at 30° (+), with flexion and rotation within the normal range. At discharge, extension was measured at 20° (+), and all other measures were within the normal range (Table 6).

Table 6 . Changes in Case 2’s range of motion (before and after treatment).

Lumbar spine ROM2023.2.8. (before treatment)2023.3.21. (after treatment)
Flexion80°80°
Extension0° (+)20° (+)
Lateral bending30° (+)/30° (+)35°/35°
Rotation45°/45°45°/45°

ROM, range of motion; +, pain while moving..


6) Radiological findings

On February 7, 2023, the patient was diagnosed with fractures in sacrum 1 and 2 through a pelvic bone CT scan at the hospital. On day 3, an X-ray of the lumbar spine revealed a dislocation of the sacrum 1 and 2 fractures. On day 24, a subsequent X-ray of the lumbar spine showed progressive fusion of the fractures in sacrum 1 and 2 (Fig. 7).

Figure 7. Case 2. The figures show sacrum 1 and 2 fractures. (A) Pelvic bone CT (2023.2.7.), (B) X-ray of the lumbar spine (2023.2.10., day 3), and (C) X-ray of the lumbar spine (2023.3.3., day 24). The arrows indicate the fracture site.

DISCUSSION

Sacral fractures are typically treated conservatively unless structural stability is lost, or neurological abnormalities occur [11]. Conventional conservative treatments include BR and mechanical traction. Integrative Korean medicine is known for reducing pain and promoting fracture fusion [13].

Acupuncture is effective in controlling pain, restoring ROM, and preventing stiffness [14]. Acupotomy was also performed in Case 2, as the patient was diagnosed with a HNP of L4–5 and spinal stenosis of L4–5 and had lower extremity pain. Lower extremity pain is a key symptom of HNP and spinal stenosis and began after the patient’s fall. However, HNP and spinal stenosis are often chronic conditions believed to have started before the patient’s fall [15]. Therefore, it seems the fall worsened the patient’s HNP of L4–5 and spinal stenosis of L4–5, revealing the lower extremity pain. Acupotomy is typically used for chronic pain. A past study found acupotomy effective for reducing pain and improving lumbar spine ROM and quality of life in patients with acute lumbosacral pain caused by trauma [16]. Pharmacopuncture combines acupuncture medicine and pharmacotherapy [17]. So-yeom pharmacopuncture exerts anti-inflammatory effects by inhibiting inflammation-related tumor necrosis factor α and interferon γ [18]. Aconitine, the main component of Cho-o pharmacopuncture, demonstrates strong anti-inflammatory and analgesic effects [19]. Depending on the patient’s symptoms, prescriptions of Dagguisu-san, Gami gunggui-tang, and Sipjeondaebotang-Gagambang were made, each with specific and unique efficacies. Dagguisu-san treats early-stage blood stasis and Gami gunggui-tang boosts energy to promote later-stage fracture fusion [20]. Sipjeondaebotang-Gagambang increases blood supply to promote fracture fusion and treats post-traumatic inertia [21]. Case 2 was prescribed Pyeongjingeonbi-tang and Gami yangwi-tang for dyspepsia and vomiting during hospitalization. Moxibustion improves circulation by heating acupoints, and dry cupping relieves pain and removes blood stasis [22].

Case 1 demonstrated improved ROM and could walk independently about 4 weeks (29 days), faster than the typical 6 weeks of immobilization in patients with moderate sacral fractures [23]. Case 2 had a lower NRS score, improved ROM, and could walk independently in 7 weeks (49 days), faster than the expected > 8 week immobilization period for severe sacral and pubic fractures [23]. Integrative Korean medicine treatment is beneficial for patients with sacral fractures by reducing lumbosacral pain while improving ROM. Additionally, radiological examinations taken before and after treatment showed progressive fusion of the fracture in both cases.

However, our results should be interpreted with caution due to several limitations. First, the cases in this study may appear heterogeneous since Case 2 also involved a pubic fracture. Yet, this left pubic fracture was classified as Tile-type A2, signifying a minimally displaced fracture without instability, and the patient did not feel pain in that region [11]. Thus, the study’s results could be considered in the context of integrative Korean medicine treatment for sacral fractures. Second, in Case 1, lumbar spine ROM improved; however, the degree of improvement was non-significant (NRS: 7.5 at admission and 7 at discharge). Conversely, in Case 2, both ROM and NRS scores improved markedly. Since the patients under BR were also undergoing walking rehabilitation to assess their ambulatory status during hospitalization, detecting NRS score changes was challenging. Nevertheless, the treatment appeared effective, as the patients ceased taking analgesics and could walk independently upon discharge. Third, this study includes only 2 cases, and in Case 2, no follow-up was conducted after discharge. Fourth, interpreting the effect of integrative Korean medicine treatment is complex due to analgesics administration and the natural healing ability of non-displaced fractures within 4–6 weeks of BR [1]. Lastly, the NRS score for lower extremity pain dropped (NRS: 8 at admission and 2 at discharge), yet isolating the effect of acupotomy treatment in Case 2 is challenging since other treatments were also applied. However, this result confirms the potential of acupotomy in treating acute lumbosacral and lower extremity pain, an area where studies remain scarce. Overall, a systematic follow-up study with a larger sample population is essential to objectively evaluate the efficacy of integrative Korean medicine treatment for sacral fractures.

AUTHOR CONTRIBUTIONS

Conceptualization: YSK, YIK. Methodology: YSK. Formal investigation: YSK. Data analysis: YSK. Writing – original draft: YSK. Writing – review & editing: All authors.

CONFLICTS OF INTEREST

The authors have no conflicts of interest to declare.

FUNDING

None.

ETHICAL STATEMENT

This study was exempt from the Daejeon Korean Medicine Hospital of Daejeon University Institutional Review Board (IRB no.: DJDSKH-23-E-12).

Fig 1.

Figure 1.Changes in Case 1’s NRS score over time. NRS, numerical rating scale.
Journal of Acupuncture Research 2023; 40: 281-292https://doi.org/10.13045/jar.2023.00171

Fig 2.

Figure 2.Case 1. Changes in gait and walking distance. ABR, absolute bed rest; CT, computed tomography; BR, bed rest.
Journal of Acupuncture Research 2023; 40: 281-292https://doi.org/10.13045/jar.2023.00171

Fig 3.

Figure 3.Case 1. The figures show the left sacral fracture. (A) Lumbar spine CT (2023.2.4., day 2) and (B) pelvic bone CT (2023.2.27., day 25). The arrows indicate the fracture site. CT, computed tomography.
Journal of Acupuncture Research 2023; 40: 281-292https://doi.org/10.13045/jar.2023.00171

Fig 4.

Figure 4.Case 1. The figures show the left sacral fracture. (A) X-ray of the lumbosacral spine (2023.2.4., day 2), (B) X-ray of the lumbosacral spine (2023.3.14.), and (C) X-ray of the sacrococcygeal spine (2023.4.21.). The arrows indicate the fracture site.
Journal of Acupuncture Research 2023; 40: 281-292https://doi.org/10.13045/jar.2023.00171

Fig 5.

Figure 5.Case 2. Changes in the NRS score over time. NRS, numerical rating scale.
Journal of Acupuncture Research 2023; 40: 281-292https://doi.org/10.13045/jar.2023.00171

Fig 6.

Figure 6.Case 2. Changes in gait and walking distance. CT, computed tomography; ABR, absolute bed rest; BR, bed rest.
Journal of Acupuncture Research 2023; 40: 281-292https://doi.org/10.13045/jar.2023.00171

Fig 7.

Figure 7.Case 2. The figures show sacrum 1 and 2 fractures. (A) Pelvic bone CT (2023.2.7.), (B) X-ray of the lumbar spine (2023.2.10., day 3), and (C) X-ray of the lumbar spine (2023.3.3., day 24). The arrows indicate the fracture site.
Journal of Acupuncture Research 2023; 40: 281-292https://doi.org/10.13045/jar.2023.00171

Table 1 . Duration and composition of herbal medicines in Case 1.

Dangguisu-san Gami, 2023.2.3. (admission) (1 d)Dose (g)Dangguisu-san, 2023.2.4.–2023.2.8. (day 2–6) (5 d)Dose (g)Gami gunggui-tang, 2023.2.9.–2023.3.3. (day 7-discharge) (23 d)Dose (g)
Angelicae Gigantis Radix6Rehmanniae Radix Recens8Angelicae Gigantis Radix20
Paeoniae Radix4Angelicae Gigantis Radix6Cnidii Rhizoma20
Linderae Radix4Paeoniae Radix4Astragali Radix8
Cyperi Rhizoma4Linderae Radix4Ginseng Radix8
Sappan Lignum4Cyperi Rhizoma4Lycii Fructus8
Carthami Flos3Sappan Lignum4Codonopsis Pilosulae Radix4
Persicae Semen3Carthami Flos2Cuscutae Semen4
Cassiae Cortex Interior2Persicae Semen2Dipsaci Radix4
Glycyrrhizae Radix et Rhizoma2Cinnamomi Ramulus2Dendrobii Caulis4
Glycyrrhizae Radix et Rhizoma2Eucommiae Cortex4
Rhei Radix et Rhizoma2Drynariae Rhizoma4
Carthami Flos4

Table 2 . Duration and composition of herbal medicines in Case 2.

Pyeongjingeonbi-tang, 2023.2.8.–2023.2.13., 2023.2.17., 2023.2.22.–2023.2.23. (admission-day 6, day 10, day 15-day 16) (9 d)Dose (g)Gami gunggui-tang, 2023.2.14.–2023.2.16., 2023.2.18.–2023.2.21. (day 7–9, day 11–14) (7 d)Dose (g)Gami yangwi-tang, 2023.2.24. (day 17) (1 d)Dose (g)Sipjeondaebotang-Gagambang, 2023.2.25.–2023.3.21. (day 18-discharge) (25 d)Dose (g)
Crataegii Fructus6Angelicae Gigantis Radix20Atractylodis Rhizoma8Ginseng Radix5
Cyperi Rhizoma4Cnidii Rhizoma20Magnoliae Cortex4Atractylodis Rhizoma Alba5
Pinelliae Tuber4Astragali Radix8Citri Unshius Pericarpium4Poria Sclerotium5
Citri Unshius Pericarpium4Ginseng Radix4Polyporus4Glycyrrhizae Radix et Rhizoma5
Cnidii Rhizoma4Lycii Fructus8Alismatis Rhizoma4Paeoniae Radix5
Atractylodis Rhizoma4Codonopsis Pilosulae Radix4Poria Sclerotium4Cnidii Rhizoma5
Atractylodis Rhizoma Alba4Cuscutae Semen4Agastachis Herba4Angelicae Gigantis Radix4
Ponciri Fructus Immaturus4Dipsaci Radix4Poria Sclerotium4Astragali Radix4
Agastachis Herba4Dendrobii Caulis4Zingiberis Rhizoma4Longan Arillus4
Magnoliae Cortex4Eucommiae Cortex4Cinnamomi Ramulus4Atractylodis Rhizoma4
Amomi Fructus4Drynariae Rhizoma4Aucklandiae Radix4Citri Unshius Pericarpium4
Massa Medicata Fermentata6Cervi Cornu4Zingiberis Rhizoma Recens4Magnoliae Cortex4
Hordei Fructus Germinatus6Zizyphi Fructus6Cyperi Rhizoma4
Glycyrrhizae Radix et Rhizoma4Cyperi Rhizoma6Pinelliae Tuber4
Aucklandiae Radix2Ponciri Fructus Immaturus6Crataegii Fructus4
Zingiberis Rhizoma Recens12Crataegii Fructus4Drynariae Rhizoma4
Zizyphi Fructus8Amomi Fructus4
Longan Arillus8

Table 3 . Medications administered during Case 1’s hospitalization.

Medication2023.2.4.–2023.2.13. (day 2–11) (10 d)2023.2.14.–2023.2.22. (day 12–20) (9 d)2023.2.23.–2023.2.28. (day 21–26) (6 d)2023.3.1.–2023.3.3. (day 27-discharge) (3 d)
Acetaminophen 325 mg, tramadol HCl 37.5 mgB, D/PC 30 minB, D/PC 30 min--
Acetaminophen 162.5 mg, tramadol HCl 18.75 mgB, D/PC 30 min-
Aceclofenac 100 mgB, D/PC 30 minB, D/PC 30 minB, D/PC 30 min
Eperisone HCl 50 mgB, D/PC 30 minB, D/PC 30 minB, D/PC 30 min
Diclofenac sodium 37.5 mg02/11 1/d
02/12 2/d
---
Tramodol HCl 25 mg02/14 1/d
02/16 1/d
--

HCl, hydrochloride; B, D/PC 30 min, breakfast, dinner/post-cibum 30 minutes; -, not applicable..


Table 4 . Changes in Case 1’s range of motion (before and after treatment).

Lumbar spine ROM2023.2.3. (before treatment)2023.3.3. (after treatment)
FlexionUnable to measure because of pain80° (+)
ExtensionUnable to measure because of pain20° (+)
Lateral bendingUnable to measure because of pain35°/35°
RotationUnable to measure because of pain45°/45°

ROM, range of motion; +, sign was marked when there was pain while moving..


Table 5 . Medications administered during Case 2’s hospitalization.

Medication2023.2.8.–2023.2.13. (admission-day 6) (6 d)2023.2.14.–2023.2.20. (day 7–13) (7 d)2023.2.21.–2023.2.27. (day 14–20) (7 d)2023.2.28.–2023.3.21. (day 21-discharge) (22 d)
Acetaminophen 162.5 mg, tramadol HCl 18.75 mgB, D/PC 30 minB, D/PC 30 min--
Aceclofenac 100 mgB, D/PC 30 minB, D/PC 30 minB, D/PC 30 min-
Eperisone HCl 75 mgB, D/PC 30 min---
Eperisone HCl 50 mgB, D/PC 30 minB, D/PC 30 min-

HCl, hydrochloride; B, D/PC 30 min, breakfast, dinner/post-cibum 30 minutes; -, not applicable..


Table 6 . Changes in Case 2’s range of motion (before and after treatment).

Lumbar spine ROM2023.2.8. (before treatment)2023.3.21. (after treatment)
Flexion80°80°
Extension0° (+)20° (+)
Lateral bending30° (+)/30° (+)35°/35°
Rotation45°/45°45°/45°

ROM, range of motion; +, pain while moving..


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Jan 07, 2025 Volume 42:1~130

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