Share on Facebook
Share on Twitter
Share on LinkedIn
Share by Email
Print
Slideshow
-
Figure. Anteroposterior radiograph of the sacrum.
-
Slide
A 68-year-old woman presents with lower back and buttock pain after a fall last week. The patient slipped on ice, falling directly on her buttock. She denies any bowel or bladder changes or pain radiating down her legs. She has full strength in her lower extremities but is having difficulty walking. Prior to the fall, the patient walked independently but after the fall she requires a walker. Radiograph of the sacrum shows a nondisplaced sacral fracture on the left (Figure).
The patient is diagnosed with a zone 1 sacral fracture (fracture lateral to the foramina). Sacral insufficiency and nondisplaced fractures are common in older patients with poor bone quality.1 The initial diagnostic study of choice includes radiographic views of the...
Submit your diagnosis to see full explanation.
The patient is diagnosed with a zone 1 sacral fracture (fracture lateral to the foramina). Sacral insufficiency and nondisplaced fractures are common in older patients with poor bone quality.1 The initial diagnostic study of choice includes radiographic views of the sacrum. Computed tomography is the best imaging study if a fracture is unclear on radiograph or to determine the amount of displacement and/or instability.2 Magnetic resonance imaging (MRI) is the study of choice to identify sacral insufficiency fractures.1,2
Nondisplaced sacral fractures are inherently stable and can be treated successfully with immediate weight-bearing. Gait assistance with a walker or crutches may be necessary for a short time period but prolonged immobilization should be avoided. Sacral fractures in patients of advanced age or associated with poor bone quality may take up to 4 months for symptom resolution. Sacral fractures that are associated with more than 1 cm of displacement or neurologic deficits require surgical treatment.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor in chief of the Journal of Orthopedics for Physician Assistants.
References
1. Mehta S, Auerbach JD, Born CT, Chin KR. Sacral fractures. J Am Acad Orthop Surg. 2006;14(12):656-665. doi:10.5435/00124635-200611000-00009
2. Karadsheh M. Sacral fractures. OrthoBullets. Accessed February 9, 2023. https://www.orthobullets.com/trauma/1032/sacral-fractures
QUESTION
This article originally appeared on Clinical Advisor
