The Debate: How to treat sacral fractures with nerve injuries?

This is a 19-year-old female involved as a passenger in a motor vehicle collision. She was stabilized at a referring hospital then transferred to the level 1 trauma center. Her major injury was to the pelvis. She is haemodynamically stable. This was a closed injury with no leg length or rotational abnormality. She had no bowel or bladder injury. There was instability to compression and distraction of her left hemi pelvis. She had too much pain to allow inline traction to detect cephalad-caudad instability. She complained of “burning pain” in the plantar aspect of her left foot, and was “hypersensitive” to plantar touch. In addition, the dorsum of her left foot had subjectively decreased sensation compared to the right foot. She had full power of dorsiflexion of the foot (5/5) but 4/5 power of plantarflexion. Representative plain radiographs and CT cuts are provided.