Displaced transverse lower sacral fractures may be associated with neurologic deficits. If so, decompression may be advisable, with or without ORIF, depending upon degree of deformity, and whether it contributes to neural compromise. Thus a careful examination is necessary to assess perineal sensation and sphincter function.
Without a neurologic deficit, nonoperative care is usually sufficient, except for extreme deformity or an associated open fracture. In the latter case debridement and ORIF are indicated.
|Displaced distal sacral fractures without indications for surgery|
- Closed A3.3 fracture with intact sacral nerve root function and acceptable deformity
|Associated sacral plexus nerve root deficit|
- Associated sacral plexus nerve root deficit
- Severe local deformity
- Open fracture
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|