A sacral fracture is a break in the sacrum – the triangular bone at the bottom of the spine which connects the pelvis to the backbone. A fracture in this area is usually due to injury from intense running or athletic training, vehicular accidents or falls. Sacral fractures are actually quite rare since the sacrum is a dense bone. It usually requires a significant amount of trauma for it to break.
Some people are, however, more prone to sacral fractures than others. They include older people and those with conditions like spina bifida, osteoporosis, rheumatoid arthritis or bone cancer. They tend to get stress or fatigue fractures. Suddenly increasing activity or wearing poorly fitting shoes can also lead to sacral fractures.
Symptoms and Diagnosis
Symptoms of a sacral fracture include pain in the lower back, buttocks, and hips or the front of the thigh and groin. Bruising or swelling around the sacral area may also be present along with bowel or bladder conditions, sexual problems or weakness in the lower limbs. CT scans, MRIs, x-rays and bone scans can all be used to take pictures of the sacrum and identify fractures and other problems.
It is more likely that sacrum pain may be due to irritation of the nerves in the area, especially the sciatic nerve which runs from the lower back, through the hips, buttocks, and down the legs. If the ligaments which hold the sacrum in place are injured, the patient can experience severe lower back and leg pain
Sacral injuries and fractures can cause serious problems. The limited movement caused by a sacral fracture can increase the risk of a blood clot in the arm or leg. This clot can travel to the heart or brain and lead to a heart attack or stroke. It can also affect the spinal cord. Treatment depends on the type of fracture.
Sacral Fracture Treatment Methods
Mild fractures caused by increased activity can heal with rest. Medicine to decrease pain and inflammation may be given so that the patient can gradually return to their usual activities. After the fracture has healed, the injured person may need to wear some type of lower back support like a brace or corset. They may also need to take part in an exercise program to increase their flexibility. It should be noted that non-surgical treatment of a sacral fracture requires frequent x-rays since there is an increased risk of bone displacement.
Serious sacral fractures may require surgery to put the bones back in their normal position. Surgery is avoided if the patient presents medical conditions that pose a risk of complications. If the fracture involves a displacement above one centimeter and is associated with soft tissue damage, persistent pain or belated displacement, an operation is necessary.
There are several methods of fixing sacral fractures including sacroplasty. This is when a medical professional injects a bone glue called polymethylmethacrylate into the fracture. The glue hardens quickly and helps to stabilize the fracture. This provides fast pain relief to patients whose quality of life is really suffering. Sacroplasty can have serious complications if not done correctly. If the fracture has also caused nerve damage, the surgeon may fixate it using metal screws and plates.
The first six to twelve weeks of physiotherapy for sacral fracture can include a range of treatments. Some options are ice/heat treatment, anti-inflammatory drugs, massage and the use of calcium and Vitamin D. Rehab will include a gradual progression to standing on full weight. During that time the patient may have to use a wheelchair, crutches or a walker. This can last from a few weeks to several months.