Transverse fractures of the upper sacrum with major displacement

Purpose of the study Transverse fractures of the upper sacrum are rare. We report a case with major displacement and neurological impairment. The use of 3D computed tomography (CT) reconstruction to facilitate preoperative planning and surgical procedure is discussed. Materials and methods A 49-year-old depressive woman jumped from the second floor in an attempt to commit suicide. She presented an absence of motor response in L5 region on both sides, hypoesthesia of S1 dermatome, perineal problems including saddle hypoesthesia and a hypotonic anal sphincter. Radiologic investigation showed a transverse fracture of the upper sacrum with major displacement. CT with 3D reconstruction visualized the course of the different fracture lines on the different levels of the sacrum. Open reduction, extensive laminectomy and internal fixation were performed 6 days following the injury. Results After a 1-year post-operative follow up, complete neurological recovery with normal walking and full perineal sphincter control was observed. Discussion and conclusion Fractures of the upper sacrum with major displacement are exceptional. They require well prepared surgical management. CT series with 3D reconstruction allow an analysis of the course of the different sagittal fracture lines to facilitate surgical planning.