ORIGINAL ARTICLE
Transverse sacral fractures with anterior displacement
George S. Sapkas Æ Andreas F. Mavrogenis Æ
Panayiotis J. Papagelopoulos
Received: 19 May 2007 / Revised: 23 July 2007 / Accepted: 13 October 2007 / Published online: 14 November 2007
Ó Springer-Verlag 2007
Abstract Transverse fractures of the sacrum with ante-
rior displacement are the rarest type of transverse sacral
fractures. They usually occur at the S1–S2 region in suicide
jumpers. A clinical study was performed to evaluate the
diagnosis, treatment and outcome of transverse sacral
fractures with anterior displacement. We present six
patients with a transverse fracture of the sacrum with
anterior displacement. All patients presented with bowel
and bladder dysfunction, perineal anesthesia, sensory and
motor deficits at the lower extremities. Prompt diagnosis of
the sacral fracture was obtained in five of the six patients.
Operative treatment including lumbosacral laminectomies,
spine instrumentation and fusion was done in all patients.
Neurological recovery was almost complete in one patient,
incomplete in four patients, and none in one patient.
Although reduction of the fracture was not ideal in many of
these patients, long-term clinical and radiographic follow-
up, and neurological improvement were rewarding.
Keywords Sacral fractures Á Transverse Á
Anterior displacement
Introduction
Isolated fractures of the sacrum are rare. They are usually
associated with fractures of the pelvic ring [1–4], or rarely
as isolated injuries [1, 5, 6]. Many studies have attempted
to describe and classify the fractures of the sacrum. Initial
report is attributed to Malgaine in 1847, while Bonin [7]
was one of the first to attempt to characterize these injuries
into six different types. Schmidek et al. [8] classified sacral
fractures into indirect and direct patterns, while Sabiston
and Wing [9] suggested a simpler classification of sacral
fractures into transverse (at the level or below the sacroiliac
joint) and vertical.
Most sacral fractures are vertical [2, 4]. Transverse
fractures of the sacrum account for approximately 5–16%
of all sacral fractures [3, 4, 8]; pelvic fractures are asso-
ciated with only 28% of transverse sacral fractures [4].
Isolated sacral fractures represent 5–10% of all sacral
injuries [6]; these fractures tend to be transverse [3].
Transverse sacral fractures usually result from high-energy
injuries such as motor vehicle accidents and falling from
height onto the lower extremities, especially in suicide
jumpers [10]. Roy-Camille et al. [10] in a clinical and
cadaveric study reported three distinct types of transverse
sacral fractures. Type 1 fracture is a flexion injury with an
anterior simple bending of the upper sacrum fragments;
type 2 fracture is a flexion fracture with a posterior dis-
placement of the upper sacrum that becomes more or less
horizontal and settles on the fractured surface of the lower
fragment; type 3 fracture is an extension fracture with
anterior displacement of the upper fragment more or less
vertical that slips downward in front of the lower fragment.
Treatment of transverse sacral fractures is difficult, both
for reduction and stabilization. These fractures have been
treated operatively and non-operatively using different
surgical procedures and techniques [1, 10–14]. The purpose
of this study is to present six patients with a transverse
fracture of the sacrum with anterior displacement, and to
emphasize the need for a comprehensive neurological
examination and adequate imaging studies. To our
G. S. Sapkas Á A. F. Mavrogenis Á P. J. Papagelopoulos (&)
First Department of Orthopaedics,
Athens University Medical School,
4 Christovassili Street, Neo Psychikon,
15451 Athens, Greece
e-mail: pjp@hol.gr
123
Eur Spine J (2008) 17:342–347
DOI 10.1007/s00586-007-0528-2