Functional outcomes of Denis Zone III sacral fractures treated nonoperatively

Objectives: 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. Design: Retrospective review of prospectively collected data of a consecutive series of patients. Setting: Level I trauma center. Patients: 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). Intervention: 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. Main Outcome Measurements: At a minimum of 2-year follow up, evaluation of SF-36 scores, Roland Morris back pain questionnaire, and Gibbons classification was conducted. Results: All fractures healed. Six patients had a postinjury increase in kyphosis (range, 1°-17°) 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. Conclusions: Nonoperative treatment of Denis Zone III sacral fractures yields consistent healing. Despite improvement in initial neurologic deficits, residual complaints were common.