• Ismaeel Baba-Rasul, Hemin M Hama Ameen, Awder Khazendar, and Seerwan O Hasan.
• Surgical Emergency Hospital, Sulaymaniyah, Kurdistan, Iraq; Department of Orthopedics, Surgical Teaching Hospital, Sulaymaniyah, Kurdistan, Iraq.
• World Neurosurg. 2017 Jan 1; 97: 758.e1-758.e5.

BackgroundIsolated lower segment sacral fracture is very rare. To the best of our knowledge, there is only one case report of S4 stable fracture that was treated conservatively.Case DescriptionHere, we report a 12-year-old girl who sustained an isolated S5 fracture with anterior displacement of S5 and coccyx on S4. The patient initially was managed conservatively 1 month and 25 days. On the failure of this treatment procedure, the patient was treated surgically by partial coccygectomy with S4-S5 fixation after reduction by 2 K-wires.ConclusionsSacral fracture is difficult to diagnose, especially when the patient has multiple injuries. This is because the emergency doctor may not perform a neurologic examination of the perineum and may miss its diagnosis. Another reason for its misdiagnosis is that the routine anteroposterior plain X-ray may not detect it. Trauma patients with sacrococcygeal pain and tenderness should raise concerns about sacral fracture, and a lateral plain X-ray and/or computed tomography of the sacrococcygeal spine should be performed. Neurologic deficit is rare in lower sacral segment fracture; hence, a trial of conservative management (same as for coccygeal fracture) should be tried first. If the patient does not respond and there is displacement, surgical intervention can be used, because it has a very good response from the patient. In the presence of a neurological deficit, however, surgical intervention should be attempted as soon as possible.Copyright © 2016 Elsevier Inc. All rights reserved.

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