Sacral Fracture

Description

• They occur in 45% of all pelvic fractures and are rarely isolated
• They are defined by the orientation of the fracture line
• Mechanism:
  • Axial compression
  • Direct posterior trauma
  • Massive crush injury
  • Insufficiency fractures in elderly and osteoporotic patients

• Above S4:
  • Neurologic injury common
  • Can see cauda equina syndrome (CES)
• Below S4:
  • Associated rectal tears
  • Neurologic injury is rare

• Lateral to sacral foramina:
  • Sciatica
  • L5 root injury
  • Neurologic deficit infrequent
• Foraminal (zone 2):
  • Bowel/bladder dysfunction
  • L5, S1, S2 root injury
  • Neurologic deficit frequent
• Canal (zone 3):
  • Bowel/bladder dysfunction
  • Sexual dysfunction
  • L5, S1 root injury
  • Neurologic deficit often present (>50%)

Etiology

• Transverse: Fall from height, flexion injuries, direct blow
• Vertical: Usually high-energy mechanism