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J Am Acad Orthop Surg, Vol 14, No 12, November 2006, 656-665.
© 2006 the American Academy of Orthopaedic Surgeons
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Sacral Fractures

Samir Mehta, MD, Joshua D. Auerbach, MD, Christopher T. Born, MD and Kingsley R. Chin, MD

Dr. Mehta is Orthopaedic Trauma Fellow, Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Seattle, WA. Dr. Auerbach is Resident, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA. Dr. Born is Professor, Department of Orthopaedic Surgery, Brown University, and Chief of Orthopaedic Trauma, Rhode Island Hospital, Providence, RI. Dr. Chin is Assistant Professor, Division of Spine Surgery, Department of Orthopaedic Surgery, University of Pennsylvania.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Mehta, Dr. Auerbach, Dr. Born, and Dr. Chin.

Reprint requests: Dr. Chin, Hospital of the University of Pennsylvania, Department of Orthopaedic Surgery, 2 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.

Sacral fractures most commonly occur after pelvic ring injuries but occasionally in isolation. Although the true incidence of sacral fractures is unknown, an estimated 30% are identified late. Sequelae of inappropriately treated or untreated sacral fractures include persistent pain, decreased mobility, and neurologic compromise. Because these fractures often result from high-energy trauma, concomitant injuries should be suspected. A thorough physical examination, including a detailed neurologic assessment and radiographic evaluation, is necessary to determine treatment. Computed tomography of the pelvis/sacrum can provide significant information about fracture pattern. Surgical intervention, often as a combination of neural decompression and stabilization, is indicated in patients with neurologic deficits, significant soft-tissue compromise, and lumbosacral instability. Patient satisfaction with surgical intervention has not been definitively documented, although neurologic improvement with timely intervention has been noted.






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