Long-term functional and radiological outcome after displaced sacral fractures

Background and objectives Displaced, unstable sacral fractures are severe injuries resulting in considerable morbidity and functional sequelae. Several authors report neurologic deficits, bladder, bowel, and sexual dysfunction, as well as residual pain and poor self-reported health, in short, and medium-term follow-up studies. However, there is a lack of information on long-term functional outcome following these injures, nor whether any changes occur in functional status many years after the initial injury. The aim of this study was to assess long-term outcome in patients after displaced sacral fractures in a 10-year perspective, focusing on dysfunctions related to the pelvic trauma and the sacral fracture. Also, by comparing the long-term outcome results with the medium-term results, changes over time could be assessed to gain more information on the development of these relatively uncommon injuries. In addition, we aimed to assess the long-term functional outcome in patients with a rare subgroup of sacral fractures, namely traumatic lumbosacral dissociation injuries. Materials and methods The present study included two clinical series, one prospective (papers 1-3) and one retrospective (paper 4). The study was conducted at Oslo University Hospital- Ullevaal (OUSU), where all patients with displaced, unstable sacral fractures were prospectively registered between 1996 and 2001 (papers 1-3). During this period, 39 patients were registered; all of whom underwent operative treatment at OUS-U, with subsequent discharge to a rehabilitation facility at Sunnaas Hospital for the majority of the patients. Tötterman et al followed 32 of the 39 patients, and published the results of functional outcome in a 1-year follow-up. In the present study, 28 of the 32 patients were available for a 10-year follow-up. Patients with traumatic Lumbosacral Dissociation (TLSD), constituting the material in Paper- IV, were retrospectively identified from the Pelvic Fracture Register at Orthopaedic department, OUS-U, between 1997 and 2006. Out of 21 eligible patients, 15 were available for follow-up, mean seven years post-injury. Seven were treated operatively and eight were treated non-operatively. All patients were examined and the following data were collected: Neurologic function in lower extremities and perineum (ASIA), bladder function (uroflowmetry, residual urine measurement, and interview), bowel function (interview), sexual function (interview, and IIEF questionnaire in ma