Influence of type of management of transverse sacral fractures on neurological outcome. A case series and review of literature

Study design: A retrospective study with review of literature. Objectives: (1) To report the management and outcome of a series of six cases of transverse sacral fractures. (2) To review the literature and see the influence of the type of treatment on the neurological outcome, in particular, of the bladder and bowel and to identify the possible factors determining this outcome. Setting: Regional spinal injury Unit, Southport, UK. Methods: Six patients with transverse sacral fractures were identified and their case notes were reviewed. The follow-up period was 4 to 17 years. A review of literature was carried out and publications that reported the outcome of function of bowel and urinary bladder were considered for the study. Results: Five of our six patients had cauda equina syndrome. Five cases were managed conservatively and one case surgically. Bladder and bowel function did not improve in three out of five cases. A review of English literature identified 18 (60 cases) of the 25 publications mentioning the outcome of bladder and bowel function. Of these, 47 cases were managed surgically, with the improvement of bladder and bowel function in 34 cases. Rest of the 13 cases were treated conservatively, with the improvement of bladder and bowel function in 10 cases. Conclusion: There is no statistical evidence of benefit of either surgical or conservative management on the outcome of bladder and bowel function. Presence of a severe angulation, displacement of fracture and neurotomesis dictate poor prognosis.