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

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 pat...

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Bibliographic Details
Published in:European journal of trauma and emergency surgery (Munich : 2007) 2015-08, Vol.41 (4), p.349-362
Main Authors: Wagner, D., Ossendorf, C., Gruszka, D., Hofmann, A., Rommens, P. M.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Critical Care Medicine
Emergency Medicine
Female
Fracture Fixation, Internal - instrumentation
Fracture Fixation, Internal - methods
Fracture Healing - physiology
Fractures
Fractures, Spontaneous - diagnosis
Fractures, Spontaneous - surgery
Humans
Intensive
Magnetic Resonance Imaging - methods
Male
Medical treatment
Medicine
Medicine & Public Health
Minimally Invasive Surgical Procedures - methods
Osteoporosis
Osteoporotic Fractures - diagnosis
Osteoporotic Fractures - surgery
Pelvic Bones - injuries
Recovery of Function
Review
Review Article
Risk Assessment
Sacrum - injuries
Sports Medicine
Surgery
Surgical Orthopedics
Tomography, X-Ray Computed - methods
Traumatic Surgery
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Description
Summary: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.
ISSN:1863-9933
1863-9941
DOI:10.1007/s00068-015-0530-z