Surgical Fixation of Geriatric Sacral U-Type Insufficiency Fractures: A Retrospective Analysis.

OBJECTIVES: To define the incidence of sacral U-type insufficiency fracture and describe management of a consecutive series of patients with this injury.

DESIGN: Retrospective analysis.

SETTING: Single Level II trauma center.

PATIENTS/PARTICIPANTS: Sixteen adult patients with sacral U-type insufficiency fractures treated over a 36-month period.

INTERVENTION: Patients were indicated for percutaneous screw fixation of the posterior pelvis if they had posterior pelvic pain that prohibited mobilization.

MAIN OUTCOME MEASUREMENTS: Visual analog scale for pain, distance ambulated on postoperative day 1, and change in sacral kyphosis.

RESULTS: The sacral U-type insufficiency fracture incidence was 16.7% (19/114); average patient age was 75 years. Delayed surgery was performed after primary nonoperative treatment had failed in 62.5% (10/16) at an average 83 days postinjury. Acute surgery was performed in 37.5% (6/16) at an average 5 days postinjury. Distance ambulated on postoperative day 1 was 114.4 feet [95% confidence interval (CI) (50.6, 178.2)] and 88.7 feet [95% CI (2.8, 174.6)] in the delayed and acute surgery groups, respectively, P = 0.18. Change in visual analog scale for pain was -3.2 [95% CI (-5.0, -1.4)] and -3.7 [95% CI (-7.0, -0.4)] in the delayed and acute surgery groups, respectively, P = 0.15. Change in sacral kyphosis from presentation to surgery was 12.3 degrees [95% CI (6.7, 17.9)] and 0.3 degrees [95% CI (-0.2, 0.9)] in the delayed and acute surgery groups, respectively, P < 0.01. Minimum follow-up was 12 months.

CONCLUSIONS: Treatment of sacral U-type insufficiency fractures by percutaneous screw fixation permits early mobilization, provides rapid pain relief, and prevents progressive deformity.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.