Functional outcome of surgically treated U-shaped sacral fractures: experience from 41 cases

Abstract

Purpose

To delineate the changes in functional outcomes of surgically treated U-shaped sacral fractures.

Methods

Forty-one patients with U-shaped sacral fractures were followed for a mean of 4.1 years after surgery. Impairment of lower extremities was assessed via a modified Gibbons score. Urinary function was assessed with a structured interview and residual urine volume. Sexual and bowel functions, as well as patient-reported health, were evaluated using a structured interview, and pain was evaluated with the visual analog scale. Comparisons of data at different time points were conducted with a mixed model, and Z-scores of the SF-36 questionnaire were calculated.

Results

Forty patients reported pain at 1 year and demonstrated no change at 2 years (p = 0.24). Thirty-six of 39 eligible patients had neurological deficits involving the lower extremities at baseline and demonstrated improvement at 1 year (p = 0.0002) but not between years 1 and 2 (p = 0.47). Twenty-three of 38 eligible patients had impaired bladder function, and 13 of 35 eligible patients had impaired bowel function at 3 months. Urinary function was worse at 2 years than at 1 year (p = 0.02). Sexual dysfunction was common, and patient-reported health was significantly worse than that of the normal population.

Conclusions

Neurological function in the lower extremities of patients with U-shaped sacral fractures improved after surgery; however, bowel and sexual functions did not change, and urinary function deteriorated over time. The majority of impairments appear to be permanent if still present at 1 year after surgery.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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