Functional outcomes of Denis zone III sacral fractures treated nonoperatively.

Abstract

The purpose of this study is to report the outcomes of nonoperative treatment in patients with Denis Zone III sacral fractures at a minimum of 2 years follow up. Retrospective review of prospectively collected data of a consecutive series of patients. Level I trauma center. A consecutive series of 15 patients (15-47 years old) with Denis Zone III sacral fractures treated nonoperatively from 1997 to 2002 was studied. Eleven patients were available for follow-up questionnaires; nine participated in a physical examination. Time to final follow up averaged 43 months (range, 25-67 months). Demographic data; mechanism of injury; injury-specific assessment of bowel, bladder, and sexual function; physical examination; and fracture pattern were collected from a prospectively collected database. At a minimum of 2-year follow up, evaluation of SF-36 scores, Roland Morris back pain questionnaire, and Gibbons classification was conducted. All fractures healed. Six patients had a postinjury increase in kyphosis (range, 1 degrees -17 degrees ) without a correlation to final outcomes. Mean SF-36 scores were all uniformly lower than the normalized general population and were biased by frequent associated injuries. Final Roland-Morris scores averaged 3.3 +/- 3.3. Gibbons classification scores initially averaged 2 +/- 1.2 and decreased to 1.5 +/- 0.8, each within their standard deviations. Eight had residual bowel, bladder, and/or sexual dysfunction. Nonoperative treatment of Denis Zone III sacral fractures yields consistent healing. Despite improvement in initial neurologic deficits, residual complaints were common.