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Transverse sacral fractures: case series and literature review.

OBJECTIVES
To report experience with transverse sacral fracture, an uncommon injury frequently associated with neurologic deficit, and to perform a meta-analysis of the literature in order to define the role of decompression for the management of sacral fractures.


DESIGN
A review of 7 cases.


SETTING
A university-affiliated tertiary care centre.


PATIENTS
Seven patients with transverse fractures of the sacrum. The mean follow-up was 13 months.


INTERVENTIONS
A review of the clinical data and a search of the literature for studies that reported on 4 or more patients with a transverse sacral fracture.


MAIN OUTCOME MEASURES
Mechanism of injury, type of neurologic deficit and its management.


RESULTS
The most common mechanism in the 7 study patients was a fall from a height. Six patients had neurologic deficits, mostly in the form of bowel or bladder disturbance. Five of these were treated with surgical decompression, and 4 of them had an improvement in neurologic function. The 7 original studies from the literature dealt with a total of 55 patients. As in the study patients, falls from a height and motor vehicle accidents predominated as the mechanisms of injury. In contrast to patients in this study, 20 of 48 patients in the literature review with neurologic deficits were treated conservatively.


CONCLUSIONS
The outcomes in this study are similar to those reported in the literature. The place of surgical decompression for patients with neurologic deficit cannot be clearly determined from the evidence currently available.