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Functional outcome of surgically treated U-shaped sacral fractures: experience from 41 cases

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Abstract

Purpose

To delineate the changes in functional outcomes of surgically treated U-shaped sacral fractures.

Methods

Forty-one patients with U-shaped sacral fractures were followed for a mean of 4.1 years after surgery. Impairment of lower extremities was assessed via a modified Gibbons score. Urinary function was assessed with a structured interview and residual urine volume. Sexual and bowel functions, as well as patient-reported health, were evaluated using a structured interview, and pain was evaluated with the visual analog scale. Comparisons of data at different time points were conducted with a mixed model, and Z-scores of the SF-36 questionnaire were calculated.

Results

Forty patients reported pain at 1 year and demonstrated no change at 2 years (p = 0.24). Thirty-six of 39 eligible patients had neurological deficits involving the lower extremities at baseline and demonstrated improvement at 1 year (p = 0.0002) but not between years 1 and 2 (p = 0.47). Twenty-three of 38 eligible patients had impaired bladder function, and 13 of 35 eligible patients had impaired bowel function at 3 months. Urinary function was worse at 2 years than at 1 year (p = 0.02). Sexual dysfunction was common, and patient-reported health was significantly worse than that of the normal population.

Conclusions

Neurological function in the lower extremities of patients with U-shaped sacral fractures improved after surgery; however, bowel and sexual functions did not change, and urinary function deteriorated over time. The majority of impairments appear to be permanent if still present at 1 year after surgery.

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Acknowledgements

The authors are grateful to Yin Li for assisting in statistical analysis and outcome interpretation. Yin Li is from State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology.

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Authors and Affiliations

  1. Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jie Fang Avenue 1095, Wuhan, China

    Li He & Chengla Yi

  2. Department of Orthopedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St, MC 0188, Denver, CO, 80204, USA

    David J. Hak

  3. Department of Orthopaedic Surgery, The Third Hospital of HeBei Medical University, Zi Qiang Avenue 139, Shijiazhuang, China

    Zhiyong Hou

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  1. Li He
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Correspondence to Chengla Yi.

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Written informed consent was obtained from all participants and was approved by the Institutional Review Board of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.

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Electronic supplementary material

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Supplementary material 1 (PPTX 3442 kb)

Supplementary Fig. 1

Images showing the variations in U-shaped sacral fractures, including the U-shaped (a), H-shaped (b), T-shaped (c), and Y-shaped (d) pattern (TIFF 9089 kb)

Supplementary material 3 (XLSX 12 kb)

Supplementary material 4 (XLSX 10 kb)

Supplementary material 5 (XLSX 10 kb)

Supplementary material 6 (XLSX 12 kb)

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He, L., Yi, C., Hak, D.J. et al. Functional outcome of surgically treated U-shaped sacral fractures: experience from 41 cases. Eur Spine J 28, 1146–1155 (2019). https://doi.org/10.1007/s00586-019-05900-x

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  • DOI: https://doi.org/10.1007/s00586-019-05900-x

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