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Sacral Fractures

Definition

  • Fracture of the Sacrum

Incidence

Aetiology

Anatomy

Classification

  • Vertical, oblique or transverse
    • Vertical
      • Denis classification of Vertical fractures
        • 3 Zones
Denis Classification of Vertical Fractures
Zone Description Nerve Injury
1 lateral to neural foramen 5% rate of nerve injury (L5 usually)
2 through neural foramen 25% rate of nerve injury
3 medial to foramen 50% rate of nerve injury – involves central sacral canal

    • Transverse fractures
      • Usually S12
      • High rate of neurological injury
      • If S23 may lead to loss of bladder and bowel function
      • Pelvic and lower lumbar spine injuries often present

Pathology

History

  • Mechanism of Injury
  • Sensory disturbance
  • Bowel | bladder function

Examination

  • Neurological Examination
  • PR
  • Identify associated injuries

Investigations

Xrays

  • often difficult to see

CT Scan

  • bone anatomy

MRI

  • soft tissue anatomy

Treatment

Nonoperative

  • Stable fractures , bed rest
  • Xray monitoring

Operative

  • Unstable or displaced
  • CR & percutaneous SI screws
  • Trans iliac bars
  • Plate and screws
  • +/- laminectomy

Complications

Prognosis