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Sacral Traumatic Fracture
Kevin R. Moore, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Pelvic ring: Pelvic bones form obliquely horizontal, ring-shaped structure around pelvic organs
                • Pelvic ring disruption: Fractures &/or ligament injuries through both anterior and posterior portions of pelvis
                  • Posterior ring fracture: Behind ischial spine; usually sacrum or sacroiliac joint
                  • Anterior ring fracture: Anterior to ischial spine, usually pubic rami

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Image Interpretation Pearls

                                        Selected References

                                        1. Eren B et al: Is spinal computed tomography necessary in pediatric trauma patients? Pediatr Int. 62(1):29-35, 2020
                                        2. Lee JS et al: Factors associated with gait outcomes in patients with traumatic lumbosacral plexus injuries. Eur J Trauma Emerg Surg. ePub, 2019
                                        3. Kempen DHR et al: Neurological outcome after traumatic transverse sacral fractures: a systematic review of 521 patients reported in the literature. JBJS Rev. 6(6):e1, 2018
                                        4. Bydon M et al: Sacral fractures. Neurosurg Focus. 37(1):E12, 2014
                                        5. Bederman SS et al: Fixation techniques for complex traumatic transverse sacral fractures: a systematic review. Spine (Phila Pa 1976). 38(16):E1028-40, 2013
                                        6. Ruatti S et al: Technique for reduction and percutaneous fixation of U- and H-shaped sacral fractures. Orthop Traumatol Surg Res. 99(5):625-9, 2013
                                        7. Porrino JA Jr et al: The importance of sagittal 2D reconstruction in pelvic and sacral trauma: avoiding oversight of U-shaped fractures of the sacrum. AJR Am J Roentgenol. 194(4):1065-71, 2010
                                        8. Schmid R et al: Lumbosacral dislocation: a review of the literature and current aspects of management. Injury. 41(4):321-8, 2010
                                        9. Sugimoto Y et al: Risk factors for lumbosacral plexus palsy related to pelvic fracture. Spine (Phila Pa 1976). 35(9):963-6, 2010
                                        10. Hak DJ et al: Sacral fractures: current strategies in diagnosis and management. Orthopedics. 32(10), 2009
                                        11. Robles LA: Transverse sacral fractures. Spine J. 9(1):60-9, 2009
                                        12. Kuklo TR et al: Radiographic measurement techniques for sacral fractures consensus statement of the Spine Trauma Study Group. Spine. 31(9):1047-55, 2006
                                        13. Bellabarba C et al: Midline sagittal sacral fractures in anterior-posterior compression pelvic ring injuries. J Orthop Trauma. 17(1):32-7, 2003
                                        14. Kim MY et al: Transverse sacral fractures: case series and literature review. Can J Surg. 44(5):359-63, 2001
                                        15. Rubel IF et al: Description of a rare type of posterior pelvis traumatic involvement: the green-stick fracture of the sarcum. Pediatr Radiol. 31(6):447-9, 2001
                                        16. Leone A et al: Lumbosacral junction injury associated with unstable pelvic fracture: classification and diagnosis. Radiology. 205(1):253-9, 1997
                                        17. Templeman D et al: Internal fixation of displaced fractures of the sacrum. Clin Orthop. (329):180-5, 1996
                                        18. Albert TJ et al: Concomitant noncontiguous thoracolumbar and sacral fractures. Spine. 18(10):1285-91, 1993
                                        19. Gibbons KJ et al: Neurological injury and patterns of sacral fractures. J Neurosurg. 72(6):889-93, 1990
                                        20. Denis F et al: Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop. 227:67-81, 1988
                                        Related Anatomy
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                                        Related Differential Diagnoses
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                                        References
                                        Tables

                                        Tables

                                        KEY FACTS

                                        • Terminology

                                          • Imaging

                                            • Top Differential Diagnoses

                                              • Pathology

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Pelvic ring: Pelvic bones form obliquely horizontal, ring-shaped structure around pelvic organs
                                                      • Pelvic ring disruption: Fractures &/or ligament injuries through both anterior and posterior portions of pelvis
                                                        • Posterior ring fracture: Behind ischial spine; usually sacrum or sacroiliac joint
                                                        • Anterior ring fracture: Anterior to ischial spine, usually pubic rami

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Image Interpretation Pearls

                                                                              Selected References

                                                                              1. Eren B et al: Is spinal computed tomography necessary in pediatric trauma patients? Pediatr Int. 62(1):29-35, 2020
                                                                              2. Lee JS et al: Factors associated with gait outcomes in patients with traumatic lumbosacral plexus injuries. Eur J Trauma Emerg Surg. ePub, 2019
                                                                              3. Kempen DHR et al: Neurological outcome after traumatic transverse sacral fractures: a systematic review of 521 patients reported in the literature. JBJS Rev. 6(6):e1, 2018
                                                                              4. Bydon M et al: Sacral fractures. Neurosurg Focus. 37(1):E12, 2014
                                                                              5. Bederman SS et al: Fixation techniques for complex traumatic transverse sacral fractures: a systematic review. Spine (Phila Pa 1976). 38(16):E1028-40, 2013
                                                                              6. Ruatti S et al: Technique for reduction and percutaneous fixation of U- and H-shaped sacral fractures. Orthop Traumatol Surg Res. 99(5):625-9, 2013
                                                                              7. Porrino JA Jr et al: The importance of sagittal 2D reconstruction in pelvic and sacral trauma: avoiding oversight of U-shaped fractures of the sacrum. AJR Am J Roentgenol. 194(4):1065-71, 2010
                                                                              8. Schmid R et al: Lumbosacral dislocation: a review of the literature and current aspects of management. Injury. 41(4):321-8, 2010
                                                                              9. Sugimoto Y et al: Risk factors for lumbosacral plexus palsy related to pelvic fracture. Spine (Phila Pa 1976). 35(9):963-6, 2010
                                                                              10. Hak DJ et al: Sacral fractures: current strategies in diagnosis and management. Orthopedics. 32(10), 2009
                                                                              11. Robles LA: Transverse sacral fractures. Spine J. 9(1):60-9, 2009
                                                                              12. Kuklo TR et al: Radiographic measurement techniques for sacral fractures consensus statement of the Spine Trauma Study Group. Spine. 31(9):1047-55, 2006
                                                                              13. Bellabarba C et al: Midline sagittal sacral fractures in anterior-posterior compression pelvic ring injuries. J Orthop Trauma. 17(1):32-7, 2003
                                                                              14. Kim MY et al: Transverse sacral fractures: case series and literature review. Can J Surg. 44(5):359-63, 2001
                                                                              15. Rubel IF et al: Description of a rare type of posterior pelvis traumatic involvement: the green-stick fracture of the sarcum. Pediatr Radiol. 31(6):447-9, 2001
                                                                              16. Leone A et al: Lumbosacral junction injury associated with unstable pelvic fracture: classification and diagnosis. Radiology. 205(1):253-9, 1997
                                                                              17. Templeman D et al: Internal fixation of displaced fractures of the sacrum. Clin Orthop. (329):180-5, 1996
                                                                              18. Albert TJ et al: Concomitant noncontiguous thoracolumbar and sacral fractures. Spine. 18(10):1285-91, 1993
                                                                              19. Gibbons KJ et al: Neurological injury and patterns of sacral fractures. J Neurosurg. 72(6):889-93, 1990
                                                                              20. Denis F et al: Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop. 227:67-81, 1988