Fragility fractures of the sacrum: how to identify and when to treat surgically?

Eur J Trauma Emerg Surg. 2015 Aug;41(4):349-62. doi: 10.1007/s00068-015-0530-z. Epub 2015 Apr 18.

Abstract

The increasing prevalence of fragility fractures of the sacrum (FFS) occurring predominantly in osteoporotic individuals poses a diagnostic and therapeutic challenge. The clinical presentation varies from longstanding low back pain without the patient remembering a traumatic event to immobilized patients after suffering a low-energy trauma. FFS are often combined with a fracture of the anterior pelvic ring; hence they are classified as a part of fragility fractures of the pelvis (FFP). If not displaced, the patients are treated with weight bearing as tolerated and analgesics; however, we advocate to treat displaced fractures surgically according to the fracture personality and the patient's comorbidities. Surgical options include minimal invasive sacro-iliac screws, trans-sacral bar osteosynthesis, open reduction and internal fixation, or spinopelvic stabilization. In the light of the high complication rate associated with immobilized patients, an operative approach often is indicated to accelerate the patient's mobility.

Publication types

  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Fracture Fixation, Internal / instrumentation
  • Fracture Fixation, Internal / methods
  • Fracture Healing / physiology
  • Fractures, Spontaneous / diagnosis
  • Fractures, Spontaneous / surgery
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Minimally Invasive Surgical Procedures / methods
  • Osteoporotic Fractures / diagnosis*
  • Osteoporotic Fractures / surgery*
  • Pelvic Bones / injuries*
  • Recovery of Function
  • Risk Assessment
  • Sacrum / injuries*
  • Tomography, X-Ray Computed / methods