Functional outcome 10 years after surgical treatment of displaced sacral fractures

Prospective, longitudinal single-cohort study of 28 patients with displaced sacral fractures treated with internal fixation.

To describe the long-term functional outcome concerning neurological deficits in the lower extremities and urinary, bowel, and sexual functions after severe sacral fractures and to compare the long-term results with the results from a previously reported 1-year follow-up of the same patient cohort.

Displaced sacral fractures may result in considerable functional morbidity. Problems concerning walking, urinary and bowel functions, and sexual dysfunctions have been reported in the short and medium term. Little is known, however, of the long-term morbidities in these patients.

Twenty-eight patients from the 1-year follow-up cohort were prospectively followed for median 10 years (range, 8-13). Sensorimotor function was classified according to the American Spinal Injury Association (ASIA) score. Urinary voiding function was assessed with uroflowmetry, and bowel and sexual functions were assessed using a structured interview. For comparison with previous data from the 1-year follow-up, the Wilcoxon signed rank test for paired samples was used.

Twenty-six patients had persistent neurological deficits in the lower extremities; one patient was not testable and only 1 was asymptomatic. Compared with preinjury, 5 had slightly changed, 11 significantly changed, and 3 completely changed urinary function. Six had a slightly changed and 2 completely changed bowel pattern. Comparing the long-term results with the 1-year data showed no significant changes in neurological deficits (P = 0.47) and bowel function (P = 0.13), whereas urinary function had deteriorated in 39% (P = 0.005). Sexual dysfunctions were reported in 44% versus 38% at the 1-year follow-up.

A high rate of impairments was observed in this study; urinary and sexual problems deteriorated over time, whereas neurological deficits of the lower extremities and bowel function did not change. These severe problems should be addressed early in the rehabilitation period and the patients should be followed by adequate expertise for many years after the injury.