Diagnostics
Diagnosis of a sacral fracture includes a complete anamnesis, which provides information about the injury mechanism and existing symptoms. This information is often sufficient to arrive at the correct diagnosis. In spite of this, a clinical examination as well as an x-ray of the pelvis in 2 planes (pelvis overview and oblique pelvic x-ray) should always be carried out to confirm the diagnosis.
In addition, a CT (computed tomography) can also be carried out to better localize the fracture and detect any concomitant injuries. During the clinical examination, it is particularly important to pay attention to possible motor or sensory deficits, as well as to determine the vascular status (palpation of pulses of the legs and feet!). In this way, possible vascular and nerve injuries can be detected early and serious consequences avoided.
Therapy
A non-dislocated, i.e. non-dislocated sacral fracture can in most cases be treated conservatively, i.e. without surgery. In this case, bed rest is initially maintained for 3-4 weeks, followed by a gradual increase in weight bearing with crutches.
In order to avoid secondary dislocations (slippage of the fractions), regular follow-up examinations should be performed. Surgical stabilization should always be performed in cases of severe fractures (i.e. those involving vascular or nerve injuries), unstable or dislocated fractures of the sacrum. Surgical stabilization is usually achieved by means of plate osteosynthesis or screw fixation.
Sacral fractures are only surgically rehabilitated in the case of a dislocated or unstable fracture, whereas simple and non-dislocated fractures can be treated conservatively (non-surgically). Various osteosyntheses are available for surgical treatment. These include stable-angle implants, plate and screw osteosyntheses.
Depending on the fracture, the lower part of the spine or pelvis must also be treated with the osteosynthesis material during surgery. The stabilization of the posterior pelvic ring is particularly important, allowing early mobilization and functionality. In addition, surgical decompression, i.e. relief of nerve and vascular structures, should be performed if necessary.
Physiotherapy plays a role in both conservative and surgical treatment of sacral fractures. Physiotherapy ensures that the mobility of patients is maintained under controlled conditions despite immobilization and protection. With the help of physiotherapists, patients also learn how to use the crutches correctly in order to expose the sacrum to only a partial load at the beginning. In addition, the physiotherapist trains the muscles, since the muscular apparatus of the hips and legs has often regressed significantly due to bed rest and rest.
