Sacral fracture

Disease Description (Causes and Symptoms)

• Definition: The sacrum is a triangular-shaped bone located between the lumbar vertebrae and the coccyx (tailbone). A sacral fracture refers to a fracture of this bone.
• Causes: Common causes include low-energy fractures due to osteoporosis in older adults, trauma (falls, landing on the buttocks), slipping in winter, and sports injuries (skiing and snowboarding). Pathologic fractures (such as metastatic lesions) may also be a cause.
• Pathophysiology: If the fracture causes bone fragments to move or damages attached ligaments and surrounding soft tissue, compression or injury of the pelvis and lower nerves (sacral nerve roots) may occur. Nerve damage may cause sensory abnormalities, abnormal sensations in the lower extremities, muscle weakness, and, in severe cases, bowel or bladder dysfunction.
• Main symptoms: Pain and tenderness in the buttocks and pelvic area, with pain that worsens when sitting. If neuropathy is present, numbness, decreased sensation, radiating pain, muscle weakness, and urinary or bowel abnormalities may occur.

Treatment Methods

• Conservative treatment (first-line treatment for most stable fractures)
  • Stabilization (rest) and activity restriction: Avoid excessive use of the fractured area. Distribute pressure by using a cushion when sitting, for example.
  • Pain control: Medications such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) may be used (as prescribed by a doctor). Short-term opioid use may be necessary.
  • Use of an orthosis: A pelvic support or brace may be used to provide stabilization and reduce pain.
  • Rehabilitation: Once the pain improves, gradually begin walking and physical therapy (strengthening and flexibility exercises).
  • Bone metabolism treatment: If osteoporosis is the cause, calcium and vitamin D supplementation and osteoporosis treatment (such as antiresorptive agents) may be considered.
• Active treatment when indicated after imaging and additional tests
  • Surgical treatment: Used for severely displaced or unstable fractures, or nerve compression (progressive neurological symptoms or bowel or bladder dysfunction). Procedures may include fixation of bone fragments (screw fixation and fusion surgery) and nerve decompression (decompression surgery).
  • Percutaneous procedures: In selected patients, pain relief and stabilization may be attempted through bone cement injection (a kyphoplasty-like procedure), although the indications are limited.
• Precautions and management of complications
  • If neurological deterioration (decreased sensation or movement, urinary incontinence, etc.) occurs, immediate emergency evaluation is required.
  • Long-term complications: Chronic pain, nonunion, deformity, or persistent neurological symptoms may occur. Deep vein thrombosis and pulmonary embolism should be considered during prolonged bed rest.

Outpatient Visit Checklist (Including Items to Bring and Sample Questions)

• Items to bring (when visiting the hospital)
  • A list of current medications (including anticoagulants and osteoporosis medications) and allergy information
  • Medical history (including osteoporosis and cancer), and a record of any recent trauma or the circumstances of a fall
  • Previous test results and imaging materials (if possible, X-ray/CT/MRI films or CDs/files)
  • A record of when symptoms began, the nature of the pain (when sitting/standing/moving), and whether there are urinary or bowel abnormalities
  • Notes on changes in daily functioning (difficulty walking and the need to use assistive devices)
• Key information to report to the doctor during the outpatient visit (examples)
  • "When did the pain start, and which movements make it worse?"
  • "Have you fallen recently or hit your buttocks hard?"
  • "Do you have abnormal sensations (a tingling feeling), weakness in your legs, or changes in your ability to control urination or bowel movements?"

Examples of General Questions to Ask the Doctor

• How is the stability of this fracture (stable vs. unstable) determined? What additional imaging tests are needed?
• Will conservative treatment be sufficient, or is surgery necessary? What are the benefits and risks of surgery?
• What medication do you recommend for pain control? What are the side effects of long-term use?
• Do I need osteoporosis testing? What prescriptions or lifestyle measures can help reduce the risk of another fracture?
• How long is the expected recovery period, and when can I resume daily activities or return to work?

Examples of Condition-Specific Questions

• Neurological symptoms/urinary or bowel-related concerns
  • "Based on my current symptoms, is nerve damage possible? Is worsening urinary or bowel function an indication for emergency surgery?"
• Imaging and treatment-related concerns
  • "Which findings on CT or MRI would indicate the need for surgery? If the displacement is small on imaging but the pain is severe, should surgery still be considered?"