SPINE FRACTURE, SACRUM
DEFINITION--A complete or incomplete break in the sacrum. This is a serious injury because it frequently damages important nerves that supply the rectum, bladder and genitals. Signs of this nerve damage may not appear for several days after injury.
BODY PARTS INVOLVED
Lumbo-sacral and sacroiliac joints.
Soft tissue around the fracture site, including muscles, nerves, tendons, ligaments, periosteum (covering to bone), blood vessels and connective tissue.
SIGNS & SYMPTOMS
Severe pain in the lower spine.
Swelling and bruising of soft tissue around the fracture.
Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal body contours.
Tenderness to the touch.
Numbness beyond the fracture site (sometimes).
Direct blow to the lower back.
Indirect stress caused by twisting or other injury to the low back.
RISK INCREASES WITH
History of bone or joint disease, especially osteoporosis.
Poor nutrition, especially calcium deficiency.
If surgery or anesthesia are needed, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or cortisone.
HOW TO PREVENT
Build your strength with a good conditioning program before beginning regular athletic practice or competition. Increased muscle mass helps protect bones and underlying tissue.
Use appropriate protective equipment, such as sacral or "tailbone" pads, when participating in contact sports.
Ensure an adequate calcium intake (1000mg to 1500mg a day) with milk and milk products or calcium supplements.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment to manipulate the broken bones or to prescribe bed rest and support with a sacral corset.
Surgery (sometimes) to set the fracture if the fractured ends are displaced, or to relieve pressure if there is evidence of nerve damage.
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the lower back region, including the pelvis and hips.
AT THE TIME OF FRACTURE:
Pressure on or injury to nearby nerves, ligaments, tendons, blood vessels or connective tissues.
Injury to the rectum. AFTER TREATMENT OR SURGERY:
Impaired blood supply to the healing bone.
Interference with bladder, rectal and sexual functions caused by postoperative swelling and pressure on nerves and blood vessels.
Avascular necrosis (death of bone cells) due to interruption of the blood supply.
Infection introduced during surgical treatment.
Unstable or arthritic spinal joint following repeated injury.
PROBABLE OUTCOMEThe average healing time for this fracture is 6 to 12 weeks. Healing is considered complete when there is no pain at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
Use a spineboard to immobilize the back while transporting the injured person to an emergency facility.
Keep the person warm with blankets to decrease the possibility of shock.
The doctor may manipulate the broken bones in surgery to return them to their normal position. Manipulation should be done as soon as possible after injury, particularly if there is evidence of injury to major nerves in the lower-back region. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
Immobilization will be necessary. Non- displaced sacrum fractures usually require a corset. Displaced fractures may require more complicated immobilization techniques such as traction.
After treatment, use ice massage if possible. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day.
Apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads or whirlpool treatments.
Massage gently and often to provide comfort and decrease swelling.
MEDICATIONYour doctor may prescribe:
General anesthesia, local anesthesia or muscle relaxants before joint manipulation.
Narcotic or synthetic narcotic pain relievers for severe pain.
Acetaminophen for mild pain.
Stool softeners to prevent constipation due to inactivity.
Antibiotics to fight infection if skin is broken or surgery is needed.
Bed rest will be necessary for 2 to 6 weeks. You will need to wear a corset for support once you begin activity.
During recovery, actively exercise all muscle groups not immobilized. These muscle contractions promote fracture alignment and hasten healing.
Begin reconditioning and rehabilitation after clearance from your doctor.
Resume normal daily activities gradually.
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when movement is comfortable. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs and symptoms of a sacrum fracture, or observe these signs in someone else.
Any of the following occur after treatment or surgery:
Loss of feeling below the fracture site.
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Nausea or vomiting.
Impaired bladder, rectal or sexual function.