Unstable sacral fractures: associated injuries and morbidity at 1 year.
METHODS
A prospective, longitudinal single-cohort study of 32 patients treated with internal fixation for unstable sacral fractures.


OBJECTIVE
To describe the prevalence of associated injuries in blunt pelvic trauma with unstable sacral fractures, and to characterize late impairments.


BACKGROUND
In high-energy pelvic ring injury, the close association of the spine, the intrapelvic organs and the bony pelvic ring result in high risk for additional injuries. These injuries may result in long-term sequels pertaining to mobility, voiding, bowel function, and sexual function. However, little is known about the components of long-term morbidity after unstable sacral fractures.


METHODS
The minimum 1-year follow-up included 32 patients surgically treated for unstable sacral fractures. Patients were analyzed for associated injuries, fracture classification, severity of trauma, and long-term measures of neurologic recovery, mobility, and functions pertaining to voiding, defecation, and sexual function.


RESULTS
Additional injuries occurred in 84%. Injury Severity Score was 27 (range, 9-57). At follow-up, sensory impairments were observed in 91%; impaired gait in 63%, and bladder, bowel, or sexual impairments in 59%. Sacral radiculopathies explained only 60% to 69% of these impairments. The presence of late impairments correlated to the severity of injury and to the presence of associated injuries, but not to fracture characteristics.


CONCLUSIONS
Unstable fractures of the sacrum are frequently associated with additional injuries. These injuries have a significant effect on morbidity still 1 year after injury. The multifactor etiology of impairments after sacral fractures should be acknowledged in the assessment of these patients.
Tötterman
Anna
A
Ulleval University Hospital, Orthopaedic Centre, Oslo, Norway. anna.totterman@ulleval.no
Glott
Thomas
T
Madsen
Jan Erik
JE
Røise
Olav
O
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D015601:Injury Severity Score; D016268:Internal Fixators; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010384:Pelvic Bones / Q000293:injuries / Q000601:surgery; D010388:Pelvis / Q000293:injuries*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D011859:Radiography; D012447:Sacrum / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D016103:Spinal Fractures / Q000150:complications / Q000453:epidemiology / Q000601:surgery*