Isolated transverse sacral fractures

Abstract

Background context: The limited literature available about transverse sacral fractures describes two populations of patients: one with severe associated injuries and neurologic impairment and another with insufficiency fractures after low-energy trauma. Nevertheless, we have observed that isolated sacral fractures can occur in a third group of patients without the previously described features.

Purpose: To describe the clinical features of a population of patients with isolated transverse sacral fractures and evaluate the results of their conservative treatment according to our experience.

Study design: Retrospective cohort study.

Patient sample: Forty-two patients with isolated transverse sacral fractures with a mean follow-up of 22 months (range, 18-24 months).

Outcomes measures: Neurologic recovery, pain relief, time out of work, and disability.

Methods: We included all the patients admitted at our institution for an isolated transverse sacral fracture between 1996 and 2005. The information obtained from their medical records was analyzed using an electronic spreadsheet (Microsoft Excel for Mac v.2011; Microsoft, Redmond, WA, USA).

Results: Thirty-four patients (80%) sustained a low-energy trauma, whereas only two (4.8%) presented transient neurologic impairment. Every fracture was confirmed with a sacrococcygeal computed tomography (CT) scan. All the patients referred no local pain 6 months after the accident and were able to return to their preinjury activity level. None of the patients required compensation for disability.

Conclusion: Transverse sacral fractures should be suspected in patients referring local pain after sustaining low-energy trauma, even in the absence of risk factors for an insufficiency fracture. These injuries are difficult to detect in plain X-rays, so a sacrococcygeal CT scan is recommended. Conservative treatment is associated with excellent results in this population of patients.