Skip to main content
SpringerLink
Log in

Sacral fractures with neurological injury: is early decompression beneficial?

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

During a 6-year period, 177 patients with a displaced sacral fracture were treated at our level-one trauma centre. At the initial presentation, 13 patients demonstrated a neurological deficit as a result of their sacral fracture. Six patients underwent surgical decompression, and seven patients were managed without surgical decompression. All patients were re-assessed at an average follow-up of 27.1 (range 12–84) months using the modified SOFCOT Index and the SF-36. Patients undergoing surgical decompression had a significantly better neurological improvement as measured by the modified SOFCOT Index (p=0.014). Moreover, patients undergoing surgical decompression had a significantly better physical function than the patients that were managed without surgical decompression, as measured by the SF-36 (p=0.044). We therefore believe that patients undergoing surgical decompression achieve better neurological improvement and better functional results.

Résumé

Pendant une période de six années, 177 malades avec une fracture déplacée du sacrum ont été traités à notre centre de trauma (niveau un). À la présentation initiale, 13 malades avaient un déficit neurologique suite à leur fracture sacrée. Six malades ont subi une décompression chirurgicale, et sept malades ont été traités sans décompression. Tous les malades étaient revus avec un délai moyen de 27,1 mois ( 12 à 84) en utilisant l’index SOFCOT modifié et le SF-36. Les malades qui avaient eu une décompression chirurgicale avaient une amélioration neurologique notablement meilleure selon l’index SOFCOT modifié (p=0.014) et une meilleure fonction quotidienne, comme mesuré par le SF-36 (p=0.044). Nous croyons par conséquent que les malades qui subissent une décompression chirurgicale ont de meilleurs résultats.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–D

Similar content being viewed by others

References

  1. Baker SP, O’Neill B (1976) The injury severity score: an update. J Trauma 16:882–885

    CAS  PubMed  Google Scholar 

  2. Bellarba C, Stewart JD, Ricci WM, DiPasquale TG, Bolhofer BR (2003) Midline sagittal fractures in anterior-posterior compression pelvic ring injuries. J Orthop Trauma 17:32–37

    Article  PubMed  Google Scholar 

  3. Denis F, Davis S, Comfort T (1988) Sacral fractures: an important problem. Clin Orthop 277:67–81

    Google Scholar 

  4. Ebraheim NA, Biyani A, Salpietro B (1996) Zone III fractures of the sacrum: a case report. Spine 21:2390–2396

    Article  CAS  PubMed  Google Scholar 

  5. Fountain SS, Hamilton RD, Jameson RM (1977) Transverse fractures of the sacrum. A report of six cases. J Bone Joint Surg [Am] 59:486–489

    Google Scholar 

  6. Gibbons KJ, Soloniuk DS, Razack N (1990) Neurological injury and patterns of sacral fractures. J Neurosurg 72:889–893

    CAS  PubMed  Google Scholar 

  7. Hersche O, Isler B, Aebi M (1993) Follow-up and prognosis of neurologic sequelae of pelvic ring fractures with involvement of the sacrum and/or the iliosacral joint. Unfallchirurg 96:311–318

    CAS  PubMed  Google Scholar 

  8. Kim MY, Reidy DP, Nolan PC, Finkelstein JA (2001) Transverse sacral fractures: case series and literature review. Can J Surg 44:359–363

    CAS  PubMed  Google Scholar 

  9. Lassale B, Garcon P. Etude Clinic de la stenose lombaire (1989) Rev Chir Orthop Reparatrice Appar Mot 75 [Suppl 1]:40–44

  10. Nork SE, Jones CB, Harding SP, Mirza SK, Routt ML (2001) Percutaneous stabilization of U-shaped sacral fractures using iliosacral screws: technique and early results. J Orthop Trauma 4:238–246

    Article  Google Scholar 

  11. Phelan ST, Jones DA, Bishay M (1991) Conservative management of transverse fractures of the sacrum with neurological features. J Bone Joint Surg [Br] 73:969–971

    Google Scholar 

  12. Pohlemann T, Gansslen A, Tscherne H (1992) The problem of the sacrum fracture. Clinical analysis of 377 cases. Orthopade 21:400–412

    CAS  PubMed  Google Scholar 

  13. Roy-Camille R, Saillant G, Gagna G, Mazel C (1985) Transverse fracture of the upper sacrum. Suicidal jumper’s fracture. Spine 10:838–845

    CAS  PubMed  Google Scholar 

  14. Sabiston CP, Wing PC (1986) Sacral fractures: classification and neurologic implications. J Trauma 26:1113–1115

    CAS  PubMed  Google Scholar 

  15. Schmidek HH, Smith DA, Kristiansen TK (1984) Sacral fractures. Neurosurg 15:735–746

    CAS  Google Scholar 

  16. Seddon H. Surgical disorders of the peripheral nerves. Edinburgh and London: Churchill Livingstone. 1972:299

  17. Taguchi T, Kawai S, Kaneko K, Yugue D (2001) Operative management of displaced fractures of the sacrum. J Orthop Sci 4:347–352

    Article  Google Scholar 

  18. Tile M (1988) Pelvic ring fractures: should they be fixed? J Bone Joint Surg [Br] 70:1–12

    Google Scholar 

  19. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopaedic Traumatology, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Kaufmann Building, Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA

    B. A. Zelle, G. S. Gruen, T. Hunt & S. R. Speth

Authors
  1. B. A. Zelle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. S. Gruen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Hunt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. R. Speth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. A. Zelle.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zelle, B.A., Gruen, G.S., Hunt, T. et al. Sacral fractures with neurological injury: is early decompression beneficial?. International Orthopaedics (SICOT) 28, 244–251 (2004). https://doi.org/10.1007/s00264-004-0557-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-004-0557-y

Keywords

Search

Navigation