Nondisplaced fractures only — displaced fractures contraindicated
Anabolic osteoporosis therapy prior to or concurrent with sacroplasty improves outcomes
Surgical fixation evidence
Percutaneous iliosacral screws for unstable fractures
Minimally invasive — lower morbidity vs. open reduction
Lumbopelvic fixation for spinopelvic dissociation
High complexity — associated with significant complication rates
Best performed at high-volume trauma centers
AO Spine AOSIS guides operative threshold
Score >=5 — operative management generally indicated
Bone healing modifiers
NSAIDs — impair prostaglandin-mediated fracture healing; limit to <2 weeks
Teriparatide — accelerates fracture healing; evidence supporting use with sacroplasty
Smoking cessation — nicotine impairs osteoblast function and fracture healing
Vitamin D repletion — essential for mineralization of healing callus
Patient Discharge Instructions
copy discharge instructions
Diagnosis and injury explanation
A fracture of the sacrum (the triangular bone at the base of the spine) has been identified
This may be due to a fall, injury, or weakening of bone from osteoporosis
The fracture is expected to heal over 8–12 weeks with rest and proper care
Activity instructions
Weight-bearing as tolerated with walker or cane for support
Avoid prolonged standing or walking until follow-up
Sit-to-stand movements should be slow and deliberate — use armrests
No lifting, bending, or twisting at the waist
Driving should not occur while taking opioid pain medications
Pain management at home
Acetaminophen 650–1000 mg every 6–8 hours as needed — do not exceed 4 g/day
Take scheduled rather than as-needed for first 1–2 weeks
Ice pack over sacral region 15–20 minutes several times daily for first 48–72 hours
Opioid medications if prescribed — take only as directed, no alcohol
Bone health
Calcium supplement 500–600 mg twice daily with meals
Vitamin D supplement 1000–2000 IU daily
Follow up with family doctor or bone specialist for DEXA scan and osteoporosis treatment
Follow-up appointments
Orthopedic or spine surgeon within 1–2 weeks
Repeat imaging may be arranged at 6–12 weeks to confirm healing
DEXA scan if not recently performed — to guide fracture prevention treatment
Return to emergency immediately for
New or worsening numbness in the saddle area (genitals, inner thighs, buttocks)
Inability to urinate or loss of bladder control
Loss of bowel control or new fecal incontinence
Progressive weakness in legs or inability to walk
Fever above 38.5 C or worsening redness or warmth over the sacrum
Sudden severe increase in pain not controlled by medications
References
Guidelines and key sources
Dreizin D, Smith EB. CT of Sacral Fractures: Classification Systems and Management. Radiographics 2022. PMID 36112523
Comprehensive CT classification review including Denis and AO Spine systems
Pelvic ring disruption association in 40–50% of high-energy sacral fractures
Rickert MM, et al. Sacral Insufficiency Fractures. JBJS Reviews 2022. PMID 35849657
Conservative management evidence and weight-bearing protocols
Insufficiency fracture natural history and outcomes
El Naga AN, Gendelberg D, Theologis AA. Injuries and Fractures of the Sacrum — A Comprehensive Review. JAAOS 2025. PMID 40623144
Most current comprehensive review of sacral fractures
Morrison WB, et al. ACR Appropriateness Criteria Stress (Fatigue-Insufficiency) Fracture Including Sacrum: 2024 Update. JACR 2024. DOI 10.1016/j.jacr.2024.08.019
Imaging algorithm and modality selection for sacral insufficiency fractures
Lee Y, et al. The Surgical Algorithm for the AO Spine Sacral Injury Classification System. Spine 2024. PMID 37970681
AOSIS scoring and operative management thresholds
Singh M, et al. Sacroplasty for Sacral Insufficiency Fractures. Journal of Clinical Medicine 2024. PMID 38398413
Sacroplasty patient selection, technique, and outcomes
Pain reduction NRS 7.8 to 0.9 at 6 months
Andresen JR, et al. Comparative Outcome of Different Treatment Options for Fragility Fractures of the Sacrum. BMC Musculoskeletal Disorders 2022. PMID 36536363
Conservative vs. sacroplasty vs. surgical fixation outcome comparison
Long B, Koyfman A, Gottlieb M. Evaluation and Management of Cauda Equina Syndrome in the Emergency Department. Am J Emerg Med 2020. PMID 31471075
Cauda equina syndrome diagnosis, imaging, and ED management
Collins AP, et al. Sacral Insufficiency Fractures: Pathology, Management, and Outcomes. JBJS Am 2025. PMID 41335115
Current outcomes and treatment algorithms
ACS Best Practices Guidelines — Spine Injury (2022) and Geriatric Trauma Management (2023)
Cauda equina syndrome management protocol
Elderly trauma cardiovascular risk assessment
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.