Sacral Fractures and Associated Injuries

Abstract

Study design: Literature review.

Objective: The aim of this review is to describe the injuries associated with sacral fractures and to analyze their impact on patient outcome.

Methods: A comprehensive narrative review of the literature was performed to identify the injuries associated with sacral fractures.

Results: Sacral fractures are uncommon injuries that result from high-energy trauma, and that, due to their rarity, are frequently underdiagnosed and mistreated. Only 5% of sacral fractures occur in isolation. Injuries most often associated with sacral fractures include neurologic injuries (present in up to 50% of sacral fractures), pelvic ring disruptions, hip and lumbar spine fractures, active pelvic/ abdominal bleeding and the presence of an open fracture or significant soft tissue injury. Diagnosis of pelvic ring fractures and fractures extending to the lumbar spine are key factors for the appropriate management of sacral fractures. Importantly, associated systemic (cranial, thoracic, and abdominopelvic) or musculoskeletal injuries should be promptly assessed and addressed. These associated injuries often dictate the management and eventual outcome of sacral fractures and, therefore, any treatment algorithm should take them into consideration.

Conclusions: Sacral fractures are complex in nature and often associated with other often-missed injuries. This review summarizes the most relevant associated injuries in sacral fractures and discusses on their appropriate management.

Keywords: associated injuries; diagnosis; management; musculoskeletal injuries; neurologic injuries; sacral fractures; systemic injuries.

Figure 1.

(A, B) Plain radiographs of a 53-year-old male with an unstable pelvis fracture. While it is visible on the radiographs, the complexities of the fracture are much more apparent on the sagittal (C), coronal (D), and 3-dimensional reconstruction (E) images from a computed tomography scan.

Figure 2.

Maurel-Lavellee lesion: Images (A) and (B) demonstrate a large fluid collection associated with the fascial degloving on axial compute tomography scan. It is important to note that this lesion is much better seen on the soft tissue window as opposed to the bone windows, which are used to evaluate the fracture. Image (C) demonstrates the intraoperative findings of a Maurel-Lavellee lesion.