Sacral Fractures

Definition

• Fracture of the Sacrum

Incidence

Aetiology

Anatomy

Classification

• Vertical, oblique or transverse
  
  • Vertical
    • Denis classification of Vertical fractures
      • 3 Zones

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