Surgical Treatment of Sacral Fractures: A Case Series Study

The sacrum bone is an integral part of the spinal column and pelvic ring. The lumbosacral neurologic function is protected by the sacrum and it maintains spinal column and pelvic alignment. For these reason, injuries to the sacrum may result in deformity, chronic pain and loss of lower extremity, bowel, bladder and sexual function. Therefore, the treatment of sacral fractures requires optimizing both neurologic and structural outcome, while also implicating a comprehensive understanding of neural decompression and skeletal reconstruction techniques (1). The severity of sacral fracture varies from insufficiency fracture in osteoporotic patients, to complex fracture pattern, resulted from high-energy trauma, such as motor vehicle accident or fall from height (1-6). The majority of sacral fractures occur in combination with pelvic fractures and the rest of them, representing only a small percent, occur either isolated or in combination of noncontiguous thoracolumbar fractures. The incidence of sacral fracture, accompanied by pelvic fracture, ranges from 40% to 50% (1, 6-10). Because of the close relationship of the sacrum and neurologic function of lower extremity and bowel, bladder and sexual function, diagnosis and treatment of sacral fracture is very important and is very challenging (6). According to the literature, sacral fractures, in 30% of patients with neurologic deficit and in 50% of patients with normal neurologic examination, had been missed (5, 6, 8, 9). Therefore, comprehensive history taking and physical examination, in combination with using diagnostic modalities and high index of suspicion of physician are mandatory for the prevention of complications, which may accompany sacral fracture, in trauma patients (5).