Sacral Fracture Fixation

⚙️What This Procedure Involves

For displaced or unstable fractures, fixation is typically achieved with percutaneous iliosacral screws placed under CT or fluoroscopic guidance, lumbopelvic fixation using pedicle screws in the lumbar spine connected by rods to iliac screws, or spinopelvic fixation for severely displaced vertical shear injuries. For sacral insufficiency fractures, sacroplasty (cement injection similar to vertebroplasty) may be performed. The procedure takes one to three hours depending on complexity.

💡Why It May Be Recommended

Surgery is recommended for displaced sacral fractures, fractures with neurological deficit (sacral nerve root compression causing bowel, bladder, or sexual dysfunction), and unstable sacral fractures as part of pelvic ring injuries.

⚖️Non-Operative Alternatives

Undisplaced sacral fractures and insufficiency fractures are usually managed with pain relief, restricted weight-bearing, and gradual mobilisation. Osteoporosis treatment is essential for insufficiency fractures.

📋Preparing for Surgery

CT scan with 3D reconstruction. MRI to assess neurological compression. Neurological assessment including bladder and bowel function.

✅Expected Benefits

Stabilisation of the fracture allowing mobilisation. Decompression of compressed nerve roots may improve neurological function, though recovery of bladder and bowel function is not guaranteed.

⚠️Common Risks

• Buttock and sacral painExpected

  Expected for several months.

• Prolonged recoveryExpected

  These are significant injuries.

🔴Less Common but Serious Risks

• Nerve root injuryUncommon

  L5 and sacral nerve roots are at risk during screw placement.

• Persistent neurological deficitUncommon

  Bladder, bowel, or sexual dysfunction may not fully recover.

• Screw malpositionUncommon

  The sacral anatomy is complex and variable.

• InfectionUncommon

  Deep infection around metalwork.

• Non-unionUncommon

  Sacral fractures may be slow to heal.

💉Anaesthetic Considerations

General anaesthesia. Prone or supine positioning depending on technique.

🏃Recovery and Rehabilitation

Weight-bearing restrictions for six to twelve weeks depending on the injury. Physiotherapy for core and pelvic strengthening. Bladder and bowel rehabilitation if neurological involvement. Full recovery six to twelve months.

📅Follow-Up

Regular X-rays and CT. Neurological monitoring. Osteoporosis management for insufficiency fractures.

❓Frequently Asked Questions