What are the implications of a sacral ala fracture?

From the Guidelines

Treatment of a sacral ala fracture depends on fracture stability and neurological involvement, with stable, non-displaced fractures managed conservatively and unstable fractures requiring surgical intervention. The management of sacral ala fractures is crucial to prevent long-term morbidity and complications. For stable, non-displaced fractures, conservative management is recommended with pain control, limited weight-bearing, and gradual physical therapy 1.

Key Considerations

• Pain control can be achieved with acetaminophen 650-1000mg every 6 hours and NSAIDs like ibuprofen 400-600mg every 6-8 hours.
• Limited weight-bearing for 6-12 weeks is essential to allow the fracture to heal.
• Gradual physical therapy can help improve mobility and strength.

Surgical Intervention

Unstable fractures with displacement or neurological deficits require surgical intervention, typically with iliosacral screws, lumbopelvic fixation, or plating techniques 1.

• Iliosacral screws can provide stable fixation for unstable sacral fractures.
• Lumbopelvic fixation can help stabilize the pelvic ring and promote healing.
• Plating techniques can be used to stabilize the sacrum and promote bone healing.

Recovery and Complications

Recovery typically takes 8-12 weeks for stable fractures and 3-6 months for surgically treated cases 1.

• Complications may include chronic pain, neurological deficits, and mobility limitations.
• Early mobilization within pain tolerance is important to prevent complications like deep vein thrombosis and pressure ulcers.
• The sacrum plays a critical role in transferring weight from the spine to the pelvis and houses important nerve roots, making prompt and effective treatment essential to prevent long-term damage.

From the Research

Sacral Ala Fracture Overview

• A sacral ala fracture is a type of fracture that occurs in the sacrum, which is a large, triangular bone at the base of the spine and the center of the pelvis 2.
• Sacral fractures are commonly associated with pelvic ring fractures due to high-energy mechanisms of injury, and can be difficult to diagnose without a computed tomography scan 2.

Diagnosis and Treatment

• The diagnosis of sacral fractures can be made using high-quality plain radiographs, computed tomography scans, and magnetic resonance imaging (MRI) 3, 2.
• The treatment of sacral fractures depends on the severity of the fracture and the presence of neurological impairment, and can include nonoperative treatment, reduction and internal fixation, or surgical fixation techniques such as percutaneously placed iliosacral screws or posterior sacral "tension band" fixation 3, 2.
• In cases where a sacral decompression is indicated, a first attempt with closed reduction through external maneuvers is not mandatory, and transcondylar traction does not represent a valid method for performing a closed decompression 3.

Outcomes and Complications

• Sacral fractures can be associated with significant morbidity, including neurological impairment, sexual dysfunction, and bowel and bladder incontinence 4, 5.
• The outcomes of patients with sacral fractures can vary depending on the severity of the fracture and the treatment approach, with some studies suggesting that patients who undergo operative treatment may have worse functional and mental/emotional outcomes than those who are treated conservatively 6.
• However, other studies have found that operative treatment can be effective in improving outcomes and reducing complications in patients with sacral fractures, particularly those with neurological impairment or instability 3, 2.