[Complex sacral fracture treated with dynamic compression plates; a case report]

Sacral fractures are uncommon injuries; published cases constitute less than 1% of all the spinal fractures. The vertical sacral fractures are more common. Based on Denis's classification for sacral fractures, those that present on area III, transverse, are still the less frequent ones and they are associated in 57% to a neurological deficit. They are link with high energy trauma. A delay in diagnosis and treatment can lead to neurologic deterioration and pain.

A 16-years-old boy fell from a moving vehicle, and suffered direct trauma to the dorsal and sacral region. He was initially assisteed in a second level hospital unit for lumbar pain, inability to walk and was unable to urinate; 4 days later to the accident he was transferred to our institution where we carried out diagnostic protocol finding a high transverse displaced fracture at S2 level with associated neurological deficit. We carried out surgical procedure, which consisted on open reduction, with a posterior approach, descompressive laminectomy and fixation with dynamic compression plate (D.C.P.) 4.5 mm in diameter. Six weeks after the surgical procedure the patient was able to walk with partial support, clear improvement in strength and sphincter control.

Transverse fractures of the sacrum are uncommon fractures; still in trauma centers the experience is limited. At the moment there is no consensus between conservative or surgical tretment modalities according the type of sacral fracture.

Today's evidence suggests that consideration must be taken on the risk of a neurological lesion associated through the surgical stabilization in comparison to the stability of the fracture site.