History

This patient fell off a horse while competing in a high level equestrian event. The patient fell directly over the sacrum and experienced immediate severe localized pain in the sacral area.

Discussion

Sacral fractures usually occur as the result of a fall upon the buttocks or following a direct traumatic blow. There are two types: Horizontal and Vertical.

Horizontal (transverse) Fractures

These are the most common type sacral fractures. The most common location is at the level of the third and fourth sacral tubercle, which is near the lower end of the sacroiliac joint. The lateral radiograph is usually required to demonstrate the fracture. Often, the lower segment of the sacrum may be displaced or angled forward.

A horizontal fracture of the upper sacrum, affecting the first or second sacral segments, may occur as a result of falls from a height. It is usually associated with suicidal attempts by jumping ("suicidal jumpers" fracture).

Vertical Fractures

These usually occur as a result of indirect trauma to the pelvis. They are visible on the frontal radiograph, but not the lateral view. The cephalic tilt-up view may be necessary to demonstrate the vertical fracture line, which usually runs nearly the entire length of the sacrum. Normally symmetrical transverse sacral foraminal lines should be carefully scrutinized for detection of the fracture line.

Isolated fractures of the sacrum are uncommon and a diligent search of the frontal radiograph for associated fracture of the pelvic rim or symphysis pubis is often beneficial.

Dr. Terry R. Yochum is a second-generation chiropractor and a cum laude graduate of the National College of Chiropractic, where he subsequently completed his radiology specialty. He is currently Director of the Rocky Mountain Chiropractic Radiological Center, in Denver, CO, an Adjunct Professor of Radiology at the Los Angeles College of Chiropractic, as well as and instructor of Skeletal Radiology at the University of Colorado School of Medicine, Denver, Co. Dr. Yochum is, also, a consultant to Health Care Manufacturing Company that offers a Stored Energy system. For more information, Dr. Yochum can be reached at: 303-940-9400 or by e-mail at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Dr. Chad Maola is a 1999 Magna Cum Laude graduate of National College of Chiropractic.

References:

1. Yochum TR, Rowe LJ. Essentials of Skeletal Radiology, ed 3. Baltimore, Williams & Wilkins, 2004.
2. Rogers LF. Radiology of Skeletal Trauma, Volume 1 & 2, New York, Churchill Livingston, 1982.