Isolated Transverse Sacrum Fracture: A Case Report

Sacral fracture commonly results from high-energy trauma. Most insufficiency fractures of the sacrum are seen in women after the age of 70. Fractures of the sacrum are rare and generally combined with a concomitant pelvic fracture. Transverse sacral fractures are even less frequent which constitute only 3–5% of all sacral fractures. This type of fractures provide a diagnostic challenge. We report a unique case of isolated transverse fracture of sacrum in a young man sustained low-energy trauma. The patient presented to our emergency department after several hours of injury, and diagnosed by clinical features and roentgenogram findings. 1. Introduction Reports of transverse fractures of the sacrum in the literature are not common. This issue has been attributed mostly to the challenge of obtaining diagnostic roentgenograms but also to the fact that this type of a fracture rarely is suspected [1]. A longitudinal fracture of the sacrum can be associated with approximately 45% of pelvic fractures. However, a transverse fracture of the sacrum is even less frequent, and accounted for only 4.5% of sacral fractures in humans [1, 2]. Lower sacral transverse fracture are often due to direct traumatic force against coccyx, and it is related to fall and resulting in break at the kyphos of sacrum mostly through the body of the lower 4-5 sacral vertebrae. Rarely, neurological deficit may accompany these fractures [2, 3]. There is often a delay in definitive diagnosis, if the quality of the roentgenograms is not adequate and if they are not examined specifically for the lesion. Most neurological insults associated with delays in diagnosis [1, 3]. Here, a case of lower fourth sacral vertebrae fracture associated with low-energy fall, who was diagnosed by clinical suspicion and appropriate roentgenogram, is reported. 2. Case Report A 37-year-old male was admitted to the emergency department (ED) with low back pain and tenderness following injury. He fell on his back onto a rough surface three hours ago. On examination, there were no weakness or anaesthesia in both the lower limbs, and inability to void urine, and to control bowel function. Roentgenogram of the pelvis revealed irregularity in the arcuate lines of the lower two sacral foramina associated with a transverse sacrum fracture through fourth sacral vertebrae (Figure 1). The fracture line from the anterior to the posterior aspect of the fourth sacral segment without narrowing of the sacral canal was confirmed later by lumbosacral tomography. As the patient had no neurological deficit, he was discharged home on