Pediatric Sacral Fractures

In Brief Study Design. Retrospective review. Objectives. To examine the epidemiologic, anatomic, mechanistic, and outcome characteristics in pediatric patients with sacral fractures and to look for correlation with the adult literature regarding sacral fractures and previous classification systems. Summary of Background Data. A review of the current literature reveals no systematic attempts to apply the results of studies of sacral fractures in adults to those in the pediatric population. Methods. We reviewed all 4876 cases of pediatric trauma at 1 children’s hospital over a 7-year period. Eight children had documented sacral fractures. Their charts were reviewed, and follow-up interviews were conducted. Results. All patients suffered either motor vehicle accidents or falls from height. Three patients’ injuries were confined to the pelvic rim including the sacrum. Mean follow-up was 38 months. Six patients had Denis Zone I injuries, 1 patient had a Zone II injury (no neurologic deficits in either category), and 1 patient had a Zone III injury with significant neurologic injury. Only this patient required surgical intervention. Long-term recovery was good in those without comorbid injuries. Conclusions. Pediatric sacral fractures are rare (0.16% of pediatric trauma). As is the case in adults, most fractures are not associated with neurologic injury. Diagnosing pediatric sacral fractures requires high clinical suspicion and thorough radiographic evaluation. Correlation of neurologic injury with certain fracture types may be possible, but will require larger studies to be confirmed. A series of eight pediatric patients with sacral fractures is presented, including epidemiologic and outcome data. Pediatric sacral fracture is a rare entity, must be diligently searched for, is frequently associated with pelvic fractures, usually results from high-impact trauma, and is rarely associated with neurologic deficits.