Sacral Fractures

Sacral fractures are relatively rare injuries. Sacral fractures are commonly one part of pelvic ring injuries and are often associated with concomitant neurologic injuries which may contribute to later morbidity. Among all pelvic ring disruptions, sacral fractures are the most difficult to reduce and stabilize. The goals of operative treatment are: (1) realignment of the sacrum and pelvic ring, (2) restoration of pelvic ring and lumbosacral stability, (3) decompression of the neural injury indirectly with fracture reduction, and (4) decompression of the neural injury directly with a sacral laminectomy (specific indications). Iliosacral screw fixation is the gold standard for fixation of AO/OTA type C vertical unstable sacral fractures. Several other types of fixation techniques are also available for vertically unstable sacral fractures, including ilio-iliacal techniques (sacral bars, transiliac plates), local sacral plates, and spinal instruments (lumbopelvic fixation). The most common method for treatment of U-shaped sacral fractures is percutaneous iliosacral screw fixation. The most unstable sacral fracture pattern is H-shaped sacral fracture. This injury causes the spine and upper central segment of the sacrum to dissociate from the pelvic ring and caudal sacral segments. Neurologic impairments are present in nearly all cases. Lumbopelvic fixation is the current surgical option for H-shaped sacral fractures with spinopelvic dissociation. An accurate reduction of all H-shaped sacral fracture components is associated with better clinical outcome.