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Transverse sacral fractures.

Luis A Robles1

  • 1Section of Neurosurgery, Hospital San Javier Marina, Puerto Vallarta Jalisco, Mexico. larob@prodigy.net.mx

The Spine Journal : Official Journal of the North American Spine Society
|November 6, 2007
PubMed
Summary
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Transverse sacral fractures (TSFs) are uncommon injuries. Surgical treatment may offer better outcomes for TSF patients, particularly regarding neurological status and fracture stability.

Area of Science:

  • Orthopedics
  • Neurosurgery
  • Trauma Surgery

Background:

  • Transverse sacral fractures (TSFs) are rare zone III sacral fractures, often involving all three Denis zones.
  • Existing classifications for TSFs are incomplete, lacking inclusion of low or special injury types.
  • Limited spine surgeon experience and a lack of established treatment protocols hinder optimal management of TSFs.

Purpose of the Study:

  • To review current principles in the evaluation, diagnosis, and treatment of transverse sacral fractures (TSFs).

Main Methods:

  • A comprehensive literature review was conducted using MEDLINE, searching English language articles from 1975 to 2006.
  • Inclusion criteria required detailed information on neurological status, treatment, and outcomes.
  • Articles lacking essential data were excluded to ensure study rigor.

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Main Results:

  • Ninety TSF cases were identified across 29 case reports/series, with high TSFs being more common and linked to high-energy trauma.
  • A high incidence of neurological impairment (97%), including radiculopathy and bowel-bladder disturbance (BBD), was observed.
  • While definitive treatment conclusions are difficult due to varied outcome reporting, surgical intervention appears associated with improved stability and neurological outcomes.

Conclusions:

  • High and low TSFs exhibit distinct characteristics, but both share a high incidence of cauda equina disturbance.
  • Neurological outcomes are primarily influenced by the anatomical features of nerve roots and the severity of fracture displacement.
  • Further research is needed to establish definitive treatment guidelines for transverse sacral fractures.