Complex sacral fractures: Surgical complications and long-term clinical outcomes in a series of patients

Abstract

Background

Complex sacral fractures with spinopelvic dissociation are rare high-energy injuries in polytrauma patients, and evidence on surgical complications and long-term health-related quality of life (HRQoL) remains limited.

Objectives

To describe surgical complications and long-term clinical, radiological, and HRQoL outcomes after spinopelvic fixation, and to analyze associations between pain/disability and clinical or radiological variables.

Methods

An ambispective single-center cohort (2012–2022) of patients with complex sacral fractures treated with spinopelvic fixation and ≥12 months of follow-up was evaluated. Clinical, radiological, and HRQoL data were collected, and bivariate correlations were performed with spinopelvic parameters and clinical variables.

Results

Twenty-eight patients (13 males, 15 females; mean age 35 years) were included. Six sustained high-speed accidents and the remaining suffered falls. According to the AO classification, 16 fractures were type C and 12 type B. Fourteen patients presented neurological deficits at admission. Postoperatively, seven patients developed deep wound infections, and two experienced new neurological deficits. At long-term follow-up, more than 60% reported persistent pain and gait disturbances. Ten patients showed neurological improvement, whereas eleven had permanent deficits. Spinopelvic parameters demonstrated overall moderate postoperative deformity, with no correlation to long-term clinical outcomes. Age correlated with Oswestry Disability Index (ODI) and Visual Analogue Scale (EVA) scores (all p < 0.05). ODI scores were also associated with Intensive Care Unit (ICU) length of stay and neurological deficits (all p < 0.05).

Conclusions

Spinopelvic fixation was associated with frequent postoperative complications – primarily deep infections and new neurological deficits – and with sustained HRQoL impairment driven by pain, mobility limitation, and reduced physical functioning. Radiological spinopelvic parameters were not related to pain or disability, while older age, prolonged ICU stay, and residual neurological deficits were associated with poorer outcomes. These findings highlight the need for improved infection prevention, neurological protection, and long-term multidisciplinary follow-up.