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Sacral Fracture

Sacral Fracture is a topic covered in the 5-Minute Emergency Consult.

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  • 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

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


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

Geriatric Considerations
Sacral insufficiency fractures should be considered in elderly patients with severe back pain

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Rosen, Peter, et al., editors. "Sacral Fracture." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307203/all/Sacral_Fracture.
Sacral Fracture. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307203/all/Sacral_Fracture. Accessed April 26, 2019.
Sacral Fracture. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307203/all/Sacral_Fracture
Sacral Fracture [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307203/all/Sacral_Fracture.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Sacral Fracture ID - 307203 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307203/all/Sacral_Fracture PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -