Sacral Fractures : Causes, Symptoms and Treatment

Sacrum is a large triangular-shaped bone that is located in the base of the spine between the two hip bones. It consists of five fused vertebrae that form the posterior part of the pelvis. The role of the sacrum is to provide structure to the body and help in movement. It provides stability to the pelvis, allowing weight bearing and transmitting forces from the upper body to the lower body.

Sacrum also has a crucial role to play in the nervous system. It has the sacral plexus, a network of nerves that supply the lower limbs, pelvic organs, and external genitalia. These nerve plexus help regulate bladder and bowel functions. Overall, the sacrum is a crucial component of the human body. It serves as a foundation for movement, providing stability, and maintaining the functioning of the nervous system.

A break or a crack in one or more of the sacral vertebrae that make up the sacrum is called a sacral fracture. It can range from minor hairline cracks to severe fractures or cracks.

A sacral fracture can occur due to trauma, fall, or accident. It can also be due to underlying conditions such as osteoporosis or cancer.

A study shows that only 5% of people with sacral fractures have a single injury.⁽¹⁾

People with sacral fractures also have pelvic ring or spine or hip fractures. It is known to occur most commonly in adults and in females with high-impact activities such as sports or heavy lifting, especially those with low bone density.⁽³⁾ A study shows that older people who have tripped or landed on their buttocks may fracture their sacrum.⁽²⁾

Trauma, osteoporosis, repetitive stress, cancer, pregnancy, and childbirth are among the common causes of sacral fractures.

Sacral fractures involve periods of rest and immobilization, pain management, and physical therapy to help restore mobility. In severe cases of sacral fracture, surgery may be needed.

The treatment for sacral fractures may depend on the severity and the underlying cause.

The symptoms of sacral fractures depend on the severity of the injury. The symptoms include:

• Pain in the lower back, hips, or buttocks which may range from mild to severe.
• Difficulty in standing and walking due to pain and weakness.
• Nerve damage resulting in numbness, tingling, or weakness in the legs.
• In sacral fractures, there may be bowel and bladder dysfunction such as incontinence or difficulty in emptying the bladder.
• There may be swelling or bruising around the site of the fracture.

If any of the above symptoms are experienced, a doctor should be consulted to determine the cause of the pain and receive appropriate treatment.

Diagnosing sacral factors can be difficult.⁽⁵⁾ There are several diagnostic tests that can be helpful in confirming sacral fractures. These include:

• X-rays can be helpful in detecting all types of sacral fractures, especially the ones that are small or located in hard-to-see areas.
• A CT scan can be done for more detailed images of the sacrum. It can be more useful in detecting complex and subtle fractures
• MRI scans are highly detailed images of the sacrum and be useful in detecting fractures that may not be visible in the x-ray of a CT scan.
• A bone scan is another technique involving injecting a radioactive substance into the bloodstream. This substance is absorbed by the actively healing bones and shows up as bright spots.
• A rectal exam may be done by the doctor to check for nerve damage.⁽⁶⁾ It can be helpful in checking whether or not the anal sphincter of a person is contracting properly.

One or more of the above tests are used by doctors to diagnose the fracture.

There are various causes and risk factors of sacral fracture.

• Trauma: This is the most common cause of sacral fracture and may include a fall from a height or motor vehicle accident.
• Osteoporosis: Osteoporosis may weaken the bone and increase the risk of developing a sacral fracture
• Cancer: Cancer such as multiple myeloma or metastatic cancer may spread to bones and weaken them.
• Pregnancy: Stress of the growing fetus during pregnancy cause stress fractures.
• Sports Injuries: Athletes participating in sports can suffer from sacral fractures due to repetitive stress on the bones.⁽³⁾
• Age and Gender: The risk of fracture is more in older adults due to the natural aging process that weakens the bones. Also, females are more at risk of developing sacral fractures due to decreased estrogen levels.
• Certain Medications: Long-term use of certain medications such as corticosteroids can increase the risk of fractures including sacral fractures.⁽⁴⁾
• Smoking: Smoking can also weaken bones and increase the risk of sacral fractures.

The treatment option for a sacral fracture depends on the individual’s overall health and the severity of the fracture.

The various treatment options for sacral fracture include:

• Rest and Pain Management: For mild sacral fractures only rest and pain management is needed.⁽⁵⁾ These include over-the-counter pain relievers or else the fracture is allowed to heal on itself.
• Physical Therapy: This helps in restoring strength and mobility to the affected area after the fracture is healed.
• Bracing: Braces are used to support the sacral region and allow the fracture to heal. Walking aids and crutches are recommended by doctors to help move around.⁽⁷⁾
• Surgery: Surgery is recommended in severe cases where stabilization is needed to promote healing. This may involve using pins, screws, and other devices to hold the bone.
• Radiation Therapy: If cancer is the cause of the fracture, radiation therapy may be needed to shrink the tumor and prevent further bone damage.
• Medications: Depending on the cause of the fracture, medications are prescribed. They help in managing and treating underlying conditions such as osteoporosis. Calcium and vitamin D supplements are also recommended by doctors.

It may take several weeks for a person with a sacral fracture to recover. A healthcare professional can be helpful in determining an appropriate treatment plan based on an individual’s specific circumstances.

There are numerous complications a sacral fracture can result in. It may depend on the severity and location of the fracture.

• Some people may experience pain even when the fracture is healed.
• There can be nerve damage during the fracture leading to numbness, weakness, and neurological symptoms
• Bone fractures can increase the risk of infection in the pelvic region.
• Sometimes the fracture may not heal properly, which may lead to nonunion or malunion of the bone.
• Sacral fracture may affect the mobility and range of motion, especially of the hip and lower back.
• In case of severe sacral fracture, bowel, and bladder function may be affected.
• Sacral fracture can also affect sexual function, especially in men.
• Chronic pain and reduced mobility can affect a person psychologically and lead to depression and anxiety.

It is important to seek treatment for sacral fracture at the earliest to avoid the risk of complications as the complications can affect the quality of life.

There are a few strategies that can help in preventing sacral fractures

• Maintaining Strong Bones: Adequate intake of calcium and vitamin D can be helpful in maintaining strong bones and reducing the risk of conditions related to osteoporosis.
• Safe Environment: Preventing falls by using handrails, non-slip mats, and proper lightening can help reduce the risk of trauma-related fractures
• Proper Technique in Sports: Practicing proper techniques and using proper protective equipment can be helpful in reducing the risk of sacral fractures.
• Prompt Treatment: Treating underlying conditions such as osteoporosis can help in reducing the risk of sacral fractures.

Living with a sacral fracture can be challenging as it can lead to pain and affect mobility. The sacral fracture can be managed with the help of the below mentioned tips:

• Following the doctor’s instructions
• Putting pressure on the affected areas should be avoided
• Use supportive devices
• Modify activities
• Practice good posture
• Eat a healthy diet

Seek support from friends and family members to help manage the emotional impact of the injury.

Living with a sacral fracture may need patience and self-care. Proper medical care and support can help people recover fully and return to normal activities.

A sacral fracture may take 8-12 weeks to recover fully.⁽⁵⁾ The time needed may depend on the extent of the person’s injury.

A sacral fracture can cause significant pain and limit mobility. It can be a challenge to day-to-day activities. With proper medical care, rest, and self-care a person can recover fully from a sacral fracture.