Sacral fracture treatment

In one series, 1) all 35 sacral fractures were treated without surgery, and only 1 patient with a complete cauda equina syndrome did not improve. Others feel that surgery may have a useful role 2):

1. operative reduction and internal fixation of unstable fractures may aid in pain control and promote early ambulation

2. decompression and/or surgical reduction/fixation may possibly improve radicular or sphincter deficits Some observations 3):

1. reduction of the ala may promote L5 recovery with Zone I fractures

2. Zone II fractures with neurologic involvement may recover with or without surgical reduction and fixation

3. horizontal Zone III with severe deficit: controversial. Reduction & decompression does not ensure recovery, which may occur with nonoperative management

To identify whether formal sacral decompression provides improvement in outcome for patients with neurologic deficit after sacral fracture compared with patients treated with indirect decompression and whether the timing of surgical decompression influences neurologic outcome?

MEDLINE was searched via PubMed using combinations of the following search terms: “Sacral fracture,” “Traumatic Sacral fracture,” “Sacral fracture decompression,” “Sacral fracture time to decompression,” “Sacral Decompression.” Only clinical studies on human subjects and in the English language were included.

Studies that did not provide sufficient detail to confirm the nature of the sacral injury, treatment rendered, and neurologic outcome were excluded. Studies using subjects less than 18 years of age, cadavers, nonhuman subjects, or laboratory simulations were excluded. All other relevant studies were reviewed in detail.

All studies were assigned a level of evidence using the grading tool described by the Centre for Evidence-Based Medicine and all studies were analyzed for bias. Both cohorts in articles comparing 2 groups of patients treated differently were included in the appropriate group. Early decompression was defined as before 72 hours.

The effect of decompression technique and timing of decompression surgery on partial and complete neurologic recovery was estimated using a generalized linear mixed model to implement a logistic regression with a study-level random effect.

There was no benefit to early decompression within 72 hours and no difference between formal laminectomy and indirect decompression with respect to neurologic recovery 4).

Sabiston CP, Wing PC. Sacral fractures: classification and neurologic implications. J Trauma. 1986; 26: 1113–1115
2) , 3)
Gibbons KJ, Soloniuk DS, Razack N. Neurological injury and patterns of sacral fractures. J Neurosurg. 1990; 72:889–893
Kepler CK, Schroeder GD, Hollern DA, Chapman JR, Fehlings MG, Dvorak M, Bellabarba C, Vaccaro AR. Do Formal Laminectomy and Timing of Decompression for Patients With Sacral Fracture and Neurologic Deficit Affect Outcome? J Orthop Trauma. 2017 Sep;31 Suppl 4:S75-S80. doi: 10.1097/BOT.0000000000000951. PubMed PMID: 28816878.
  • sacral_fracture_treatment.txt
  • Last modified: 2020/02/01 09:51
  • by administrador