Surgical Treatment of Sacral Fractures: A Case Series Study

Background: The sacrum bone is an integral part of pelvis and spinal column. It protects lumbosacral neurologic plexus and maintains the spinal column and pelvic alignment. Therefore, injury to the sacrum may lead to neurologic deficit, pain and disability. Due to difficulties in radiologic diagnosis and associated injuries, sacral fractures are usually missed or diagnosed late. Objectives: To evaluate the clinical and functional outcome of surgical treatment of high-energy traumatic sacral fractures. Patients and Methods: All patients with sacral fractures, who had undergone surgical treatment, were evaluated retrospectively and data were collected. Fracture type, preoperative and postoperative neurologic examination, according to the American spinal injury association (ASIA) score and Gibbons’ classification and visual analogue scale (VAS) were evaluated. In addition, postoperative complications, such as infection, deep venous thrombosis (DVT), rod breakage, screw loosening and dislodgment were assessed. Results: Of the 27 patients with sacral fracture that were treated surgically, 15 (55.4%) patients were female and 12 (44.6%) were male. Fourteen (51.8%) patients underwent percutaneous iliosacral screw fixation and 13 (48.1%) patients underwent spinopelvic fixation. Three (11.1%) patients had neurologic deficit. After neurologic decompression, two of them recovered completely (with preoperative Gibbon’s grade 2, 3) and one of them, with Gibbons’ grade 4, improved incompletely in motor power and also remained incontinent after a year postoperatively. None of them developed postoperative infection, DVT, rod breakage or screw loosening or breakage. Only one patient, in the unilateral spinopelvic fixation group, developed asymptomatic rod dislodgment from distal (iliac) fixation. In all patients, VAS score changed substantially from mean 8, preoperatively, to mean 1, postoperatively. Conclusions: For no displaced or minimally displaced sacral fractures and fractures without comminution, especially in young and nonosteoporotic patients, (Denis type 1 and 2) percutaneous iliosacral screw fixation could be an ideal treatment. For Denis type 3, spinopelvic dissociation, comminuted Denis type 1 and 2 and for sacral fracture in osteoporotic or elder patients, spinopelvic fixation may be the treatment of choice, with acceptable outcome.