Association between Sacral Fractures and Pelvic Ring Injuries: A Correlative Study of Fracture Morphologies

To investigate, in a retrospective cohort, the association between sacral fractures and pelvic ring injuries (PRIs) by correlating their respective classification subtypes.

We selected 45 patients admitted to a tertiary trauma center between March 2023 and May 2025. Imaging studies were evaluated for the presence of PRIs and sacral fractures, followed by their classification according to the Tile and Denis systems. Then, a statistical analysis was performed using the McNemar-Bowker test and the Cramér's V coefficient to assess the strength of the association.

Among the PRIs classified according to the Tile system, type B was predominant (62.22%), followed by type C (35.56%), and type A (2.22%). Among the sacral fractures classified according to the Denis system, type I was the most prevalent (50%), followed by type II (28.57%), and type III (21.43%). When the classifications were correlated, Tile type-B PRIs showed an 85.7% incidence of associated sacral fractures, 66.6% of which were Denis type I. For Tile type-C PRIs, the incidence of associated sacral fractures was of 100%, with 50% classified as Denis type II. There was a significant association between the Tile and Denis classifications ( p  < 0.001), with a moderate correlation (Cramér's V = 0.27-0.35).

The study suggests correlations between PRIs and sacral fracture subtypes, with Tile B-Denis I and Tile C-Denis II representing the most frequent associations. This relationship may facilitate diagnostic investigation and improve patient outcomes.