Surgical management of sacral fractures: A comprehensive series and review at a Level I trauma center

Objective

This case series aims to classify various sacral fractures and their surgical treatment to generate more comprehensive treatment strategies and improve standardization of care.

Methods

After obtaining IRB approval, sacral fractures managed surgically among five surgeons at a Level I trauma center in New York City were collected retrospectively from the five surgeons’ case logs from 2007 to 2021. Pre-operative imaging was retrospectively gathered for each sacral fracture and classified using the AO spine, Denis, Modified Roy-Camille, Isler and lumbosacral injury classification system (LSICS) schemas. Each classification was correlated to LSICS.

Results

A total of 42 patients were included; 14 patients were treated by neurosurgery alone, 17 patients were treated by orthopedics alone, and 11 patients were treated by both neurosurgery and orthopedic surgery. Lumbopelvic or iliosacral fixation was used independently or in combination. Roy-Camille classification significantly correlated with LSICS severity scores, while other systems did not. Fixation type was not predicted by any classification system, suggesting variability in surgical technique.

Conclusion

Sacral fractures represent an area of growing collaboration between neurosurgeons and orthopedic surgeons. This study suggests that the Roy-Camille and Denis classifications correlate with LSICS scores of sacral fractures. Classification systems inconsistently correlate with injury severity and do not predict fixation choice. Surgical management of sacral fractures should be individualized, highlighting the need for standardized fixation guidelines.