Nonoperative immediate weightbearing of minimally displaced lateral compression sacral fractures does not result in displacement

摘要

OBJECTIVES: The purpose of this study was to compare the initial and follow-up radiographs of patients with minimally displaced lateral compression (LC) sacral fractures treated nonoperatively with immediate weightbearing to determine the amount of displacement that occurs during healing. DESIGN: Retrospective review. SETTING: Single academic urban Level I Trauma Center. PATIENTS/PARTICIPANTS: We evaluated 118 patients with a LC sacral fracture with <10 mm of displacement. There were 70 women and 48 men whose average age was 46 years and injury severity score was 15 ± 11. INTERVENTION: Nonoperative treatment consisted of immediate foot-flat mobilization and advancement of weightbearing as tolerated. Repeat radiographs were routinely obtained once the patient had ambulated 50 feet or at 1 week to look for further displacement. Patients were followed with AP radiographs in the clinic at the 4- to 6-week and 10- to 12-week periods, and then every 6-8 weeks until they were healed. MAIN OUTCOME MEASURES: Specific measurements were made on the initial and follow-up radiographs by 2 observers not involved in the treatment of the patients. A vertical plumb line drawn through the center of the S1 and S2 bodies served as an anchoring point for measurements. Key landmarks were measured on each side of the pelvis, which allowed for determination of the initial and final displacements. RESULTS: All patients presenting to our center with LC sacral fractures with <10 mm of displacement were treated nonoperatively. One patient failed nonoperative management, demonstrating 5 mm of additional sacral displacement and having substantial pain with attempts to mobilize. This patient was treated with closed reduction and percutaneous pinning of the sacrum and an anterior external fixator. The other 117 patients (99%) healed with minimal additional displacement. CONCLUSIONS: Immediate weightbearing, tempered by patient comfort, is a safe and acceptable treatment for minimally displaced LC sacral fractures and results in union with minimal additional displacement. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.