Functional outcome of surgically treated U-shaped sacral fractures: experience from 41 cases

  • Li He
  • Chengla YiEmail author
  • David J. Hak
  • Zhiyong Hou
Original Article



To delineate the changes in functional outcomes of surgically treated U-shaped sacral fractures.


Forty-one patients with U-shaped sacral fractures were followed for a mean of 4.1 years after surgery. Impairment of lower extremities was assessed via a modified Gibbons score. Urinary function was assessed with a structured interview and residual urine volume. Sexual and bowel functions, as well as patient-reported health, were evaluated using a structured interview, and pain was evaluated with the visual analog scale. Comparisons of data at different time points were conducted with a mixed model, and Z-scores of the SF-36 questionnaire were calculated.


Forty patients reported pain at 1 year and demonstrated no change at 2 years (p = 0.24). Thirty-six of 39 eligible patients had neurological deficits involving the lower extremities at baseline and demonstrated improvement at 1 year (p = 0.0002) but not between years 1 and 2 (p = 0.47). Twenty-three of 38 eligible patients had impaired bladder function, and 13 of 35 eligible patients had impaired bowel function at 3 months. Urinary function was worse at 2 years than at 1 year (p = 0.02). Sexual dysfunction was common, and patient-reported health was significantly worse than that of the normal population.


Neurological function in the lower extremities of patients with U-shaped sacral fractures improved after surgery; however, bowel and sexual functions did not change, and urinary function deteriorated over time. The majority of impairments appear to be permanent if still present at 1 year after surgery.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


U-shaped sacral fractures Functional outcome Neurological deficits Patient-reported health Surgical treatment 



The authors are grateful to Yin Li for assisting in statistical analysis and outcome interpretation. Yin Li is from State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest in the submission of this manuscript.

Informed consent

Written informed consent was obtained from all participants and was approved by the Institutional Review Board of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology.

Supplementary material

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Supplementary material 1 (PPTX 3442 kb)
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Supplementary Fig. 1 Images showing the variations in U-shaped sacral fractures, including the U-shaped (a), H-shaped (b), T-shaped (c), and Y-shaped (d) pattern (TIFF 9089 kb)
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Supplementary material 6 (XLSX 12 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Traumatic Surgery, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
  2. 2.Department of Orthopedics, Denver Health Medical CenterUniversity of Colorado School of MedicineDenverUSA
  3. 3.Department of Orthopaedic SurgeryThe Third Hospital of HeBei Medical UniversityShijiazhuangChina

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