• OBJECTIVE
    • Use modern computed tomographic imaging to reassess neurological injury risks associated with zone I-III sacral fractures as originally described by Denis et al.
  • DESIGN
    • Retrospective case-control study.
  • SETTING
    • University Level I Trauma Center.
  • PATIENTS/PARTICIPANTS
    • One thousand five hundred seven consecutive patients who presented with sacral fractures between January 2000 and August 2012.
  • MAIN OUTCOME MEASUREMENTS
    • Patients were stratified based on the diagnosis of acute neurological injury. The risk of severe and complex sacral fractures based on the presence of nerve injury was assessed.
  • RESULTS
    • The rate of nerve injury was significantly lower compared with historic data (3.5% vs. 21.6%, P < 0.001). Acute nerve injury was a significant risk factor for displaced (odds ratio [OR]: 8.4, 95% confidence interval [CI], 1.4-51.9) and comminuted (OR: 5.2, 95% CI, 1.7-16.3) sacral fractures as well as zone II (OR: 3.4, 95% CI, 1.1-10.1) and III (OR: 3.9, 95% CI, 1.0-16.4) fractures.
  • CONCLUSIONS
    • The incidence of nerve injuries associated with sacral fractures is significantly lower than originally published by Denis et al. Patients with a nerve injury were highly correlated with having a displaced, comminuted, or zone III fracture, or spinopelvic dissociation; the authors recommend a fine cut computerized tomography for further investigation if these findings are not apparent on initial radiographic imaging.
  • LEVEL OF EVIDENCE
    • Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.