Sacral U-type Fractures in Patients Older Than 65 years

Abstract

Introduction: The purpose of this study was to determine the degree of disability that geriatric patients with sacral U-type fractures experience.

Methods: Patients older than 65 years presenting from 2013 to 2019 with a U-type sacral fracture were included. Patient demographics, treatment type, preinjury domicile, preinjury use of assistive devices, and neurologic deficits were recorded. Outcomes included mortality, return to preinjury domicile, and use of assistive devices for mobility.

Results: Among 46 patients in the treatment period, ground-level fall was the most common mechanism of injury (60.8%). Thirty-four patients (74%) were treated surgically, most commonly with closed percutaneous fixation (n = 27). Thirteen percent of patients died during the admission. At the final follow-up, 14 (45%) had not returned to their prior domicile and 18 (58%) required more supportive assistive devices. Seventy-three percent of patients who presented delayed required a new gait aid, compared with 47% presenting acutely. Between those presenting with low-energy versus high-energy mechanisms, similar rates of need were observed for new assistive devices (50% low and 73% high) and lack of return to preinjury domicile (40% low, 50% high).

Discussion: Many geriatric patients were disabled by or died after sustaining a sacral U-type fracture, highlighting the morbidity regardless of high-energy or low-energy trauma.

Figure 1

Imaging showing an 88-year-old woman with a history of atrial fibrillation, previously an independent community ambulator with a cane. She presented following a ground-level fall (GLF) to an outside hospital. Radiographs were obtained, and she was found to have inferior and superior pubic rami fracture and she was discharged to a skilled nursing facility (SNF). She had persistent pain and difficulty with weight-bearing with therapies. Subsequently, nearly 2 weeks following the fall, she presented to an outside orthopaedic surgeon who obtained a CT scan, which demonstrated a sacral U-type fracture, and she was transferred for further management (A and B). Upon presentation at our institution, she remained neurologically intact and underwent percutaneous fixation with a fully threaded TSTI screw through S1 corridor (C and D). She was discharged to a SNF; at the final 3-month follow-up, she continued to reside at the SNF, using a walker and cane for ambulation.