• Benjamin R Pulley, Steven B Cotman, and FowlerT TyTTDepartment of Orthopaedic Surgery, Mount Carmel Health System, Columbus, OH.Orthopedic ONE, Columbus, OH..
• Orthopaedic Trauma Service, Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA.
• J Orthop Trauma. 2018 Dec 1; 32 (12): 617-622.

ObjectivesTo define the incidence of sacral U-type insufficiency fracture and describe management of a consecutive series of patients with this injury.DesignRetrospective analysis.SettingSingle Level II trauma center.Patients/ParticipantsSixteen adult patients with sacral U-type insufficiency fractures treated over a 36-month period.InterventionPatients were indicated for percutaneous screw fixation of the posterior pelvis if they had posterior pelvic pain that prohibited mobilization.Main Outcome MeasurementsVisual analog scale for pain, distance ambulated on postoperative day 1, and change in sacral kyphosis.ResultsThe sacral U-type insufficiency fracture incidence was 16.7% (19/114); average patient age was 75 years. Delayed surgery was performed after primary nonoperative treatment had failed in 62.5% (10/16) at an average 83 days postinjury. Acute surgery was performed in 37.5% (6/16) at an average 5 days postinjury. Distance ambulated on postoperative day 1 was 114.4 feet [95% confidence interval (CI) (50.6, 178.2)] and 88.7 feet [95% CI (2.8, 174.6)] in the delayed and acute surgery groups, respectively, P = 0.18. Change in visual analog scale for pain was -3.2 [95% CI (-5.0, -1.4)] and -3.7 [95% CI (-7.0, -0.4)] in the delayed and acute surgery groups, respectively, P = 0.15. Change in sacral kyphosis from presentation to surgery was 12.3 degrees [95% CI (6.7, 17.9)] and 0.3 degrees [95% CI (-0.2, 0.9)] in the delayed and acute surgery groups, respectively, P < 0.01. Minimum follow-up was 12 months.ConclusionsTreatment of sacral U-type insufficiency fractures by percutaneous screw fixation permits early mobilization, provides rapid pain relief, and prevents progressive deformity.Level Of EvidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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